Organization
CCG PRESCOTT, INC
Active
Other names
Prescott Nursing and Rehabilitation Community
Organization subpart
No
Provider details
NPI number
Authorized official
KEITH YODER (CFO)
(614) 416-0600
Entity
Organization
Contact information
Practice address
1505 ORRIN RD, PRESCOTT, WI 54021-1074
(715) 262-5661
(715) 262-4899
Mailing address
5000 HAKES DR, SUITE 600, NORTON SHORES, MI 49441-5574
(231) 799-6870
(231) 799-0250
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
3249
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
20195300
—
WI
Enumeration date
08/19/2005
Last updated
01/23/2008
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