Organization
GOLDEN SANDS RCS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DIANA MAY WITUCKI (PRESIDENT)
(920) 787-0777
Entity
Organization
Contact information
Practice address
220 W MAIN ST, WAUTOMA, WI 54982-5411
(950) 787-0777
(920) 787-4158
Mailing address
220 W MAIN ST, P.O. BOX 1141, WAUTOMA, WI 54982-5411
(920) 787-0777
(920) 787-4158
Taxonomy
Speciality
Code
Description
License number
State
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
—
—
Other
Enumeration date
08/23/2010
Last updated
08/23/2010
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