Organization
MGM-EASTVIEW
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TINA BRANDT (REHAB TECH)
(715) 623-2356
Entity
Organization
Contact information
Practice address
729 PARK ST, ANTIGO, WI 54409-2745
(715) 623-2356
Mailing address
PO BOX 219, 340A MAIN STREET, BIRNAMWOOD, WI 54414-0219
(920) 606-2811
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
5265
WI
Other
Enumeration date
05/05/2016
Last updated
05/05/2016
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