| NPI | 1770724940 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE WILLIAMS Wi Medicaid Billing Specialist 479-201-2844 |
| Organization Subpart ? | No |
| Primary Taxonomy | 314000000X Skilled Nursing Facility (Licence: WI 11132-024) |
| Enumeration Date | 2009-03-17 |
| Last Update Date | 2009-03-17 |