COUNTY OF MONROE CLERK COURT
Intermediate Care Facility, Mentally Retarded
Sparta, Wisconsin
Provider NPI: 1942362108
Organization Information:Organization Name: COUNTY OF MONROE CLERK COURT
Practice Location:
14345 COUNTY HIGHWAY B SPARTA, WI 54656 US
Tel: 608-269-8800 Fax: --
Business Mailing Address:
,
Tel: -- Fax: --
Taxonomy:
Other Provider Identifiers:
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin
Practice Location:
14345 COUNTY HIGHWAY B SPARTA, WI 54656 US
Tel: 608-269-8800 Fax: --
Business Mailing Address:
,
Tel: -- Fax: --
Taxonomy:
Primary | Code | Category/Description | State | License Number |
---|---|---|---|---|
Y | 315P00000X | Nursing & Custodial Care Facilities Intermediate Care Facility, Mentally Retarded | WI | ========= |
Other Provider Identifiers:
Issuer | Number | State | Type |
---|---|---|---|
21052600 | WI | 05 |
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin