Organization
COUNTY OF TREMPEALEAU
Active
Parent organization
COUNTY OF TREMPEALEAU
Other names
Clover Way RCAC
Organization subpart
Yes
Provider details
NPI number
Legal business name
COUNTY OF TREMPEALEAU
Authorized official
JERRY DEETZ N.H.A. (EXECUTIVE DIRECTOR)
(715) 538-4312
Entity
Organization
Contact information
Practice address
36125 E END RD, INDEPENDENCE, WI 54747-8080
(715) 985-2270
Mailing address
W20410 STATE ROAD 121, WHITEHALL, WI 54773-9147
Taxonomy
Speciality
Code
Description
License number
State
3104A0625X
Assisted Living Facility (Mental Illness)
Primary
12483
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
12483
—
WI
Enumeration date
03/03/2009
Last updated
04/15/2021
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