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Organization

GL HEALTHCARE

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MS. ILENE LARSON PT (OWNER)
(608) 223-1452
Entity
Organization

Contact information

Practice address
470 GARFIELD AVE, EVANSVILLE, WI 53536-1014
(608) 882-6557
(608) 882-6559
Mailing address
2620 WAUNONA WAY, MADISON, WI 53713-1525
(608) 223-1452

Taxonomy

Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
963-019
WI

Other

Enumeration date
08/05/2007
Last updated
08/05/2007
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