Organization
ST. COLETTA OF WISCONSIN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN HEINDEL (VICE PRESIDENT FINANCIAL SERVICES)
(920) 674-8287
Entity
Organization
Contact information
Practice address
W4955 US HIGHWAY 18, JEFFERSON, WI 53549-9702
(920) 674-4330
(920) 674-8422
Mailing address
W4955 US HIGHWAY 18, JEFFERSON, WI 53549-9702
(920) 674-4330
(920) 674-8422
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
1109
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20009700
PROVIDER NUMBER
WI
Enumeration date
05/01/2007
Last updated
08/22/2020
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