Organization
BV/MSTAR CALEDONIA TENANT, LLC
Active
Other names
The Woods of Caledonia
Organization subpart
No
Provider details
NPI number
Authorized official
MR. HENRY JAMES VAUGHN (REIMBURSEMENT ANALYST)
(240) 595-6025
Entity
Organization
Contact information
Practice address
5737 ERIE ST, RACINE, WI 53402-1970
(262) 639-6025
(262) 639-5279
Mailing address
5737 ERIE ST, RACINE, WI 53402-1970
(262) 639-6025
(262) 639-5279
Taxonomy
Speciality
Code
Description
License number
State
311500000X
Alzheimer Center (Dementia Center)
Primary
—
—
Other
Enumeration date
10/23/2020
Last updated
10/23/2020
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