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ST. COLETTA OF WISCONSIN

Intermediate Care Facility, Mentally Retarded

Jefferson, Wisconsin

Provider NPI: 1871714543

Organization Information:
Organization Name:  ST. COLETTA OF WISCONSIN


Practice Location:
W4955 US HIGHWAY 18  JEFFERSON, WI 53549 US
Tel: 920-674-4330  Fax: --

Business Mailing Address:
  ,   
Tel: --  Fax: --


Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
Y315P00000XNursing & Custodial Care Facilities
Intermediate Care Facility, Mentally Retarded
WI1109

Other Provider Identifiers:

IssuerNumberStateType
PROVIDER NUMBER20009700WI01
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin




MENTALLY RETARDED JOBS WI - Page 1



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