| NPI | 1326170267 |
|---|---|
| Doing Business As | HICKORY RIDGE ADULT FAMILY HOME |
| Entity Type | Organization |
| Authorized Contact | JERRU DEETZ Executive Director 715-538-4312 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home (Licence: WI 11796) |
| Enumeration Date | 2007-03-09 |
| Last Update Date | 2021-04-15 |