Country Grove Home LLC
Organization Active NPI Assisted Living Facility (Mental Illness) · Necedah, WI
NPI 1306162706 · NPPES record last updated Apr 12, 2010
Key facts
- NPI
- 1306162706
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Assisted Living Facility (Mental Illness) 3104A0625X
- License
- 0011011 (WI)
- Legal business name
- COUNTRY GROVE HOME LLC
- Practice address
- N11151 17TH Ave
Necedah, WI 54646-7619 - Phone
- (608) 565-2735
- NPI assigned
- Apr 12, 2010
- Organization subpart
- No
Authorized official
- Name
- Mr. Scott A Peak
- Title
- Owner
- Phone
- (608) 547-2755
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Assisted Living Facility (Mental Illness) | 3104A0625X | 0011011 | WI | Yes |
Addresses
Primary practice location
N11151 17TH Ave
Necedah, WI 54646-7619
Mailing address
N10414 18TH Ave
Necedah, WI 54646-7934
Phone (608) 547-2752
Other providers in Necedah, WI
- Tracy Anderson
- C.J. Karas, D.D.S. of Necedah.S.C
- Deer Path Integrated Inc
- Deer Path Integrated, Inc.
- Erica Alexandra Falk-Huzar
- John A Glavin
- Jessica Koluch
All providers in Necedah, WI · Assisted Living Facility (Mental Illness) in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 12, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.