Organization
EDGEWOOD CARE CENTER INC.
Active
Other names
Heritage Manor
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ELLSWORTH L JOHNSON (CEO)
(952) 929-2122
Entity
Organization
Contact information
Practice address
307 ROYALL AVE, ELROY, WI 53929-1044
(608) 462-8491
(608) 462-5088
Mailing address
PO BOX 167, 307 ROYALL AVE, ELROY, WI 53929-0167
(608) 462-8491
(608) 462-5088
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
2852
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
20117500
—
WI
Enumeration date
08/02/2005
Last updated
04/20/2012
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