Organization
TDR, INC.
Active
Other names
Rennes Health Center - East
Organization subpart
No
Provider details
NPI number
Authorized official
NEIL JOHNSON (TREASURER)
(715) 582-2200
Entity
Organization
Contact information
Practice address
701 WILLOW ST, PESHTIGO, WI 54157-1165
(715) 582-3962
Mailing address
261 FRENCH ST, PESHTIGO, WI 54157-1217
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
3118
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
20173100
—
WI
05
—
21053600
—
WI
Enumeration date
07/08/2005
Last updated
01/22/2009
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