NPIMap

Organization Active NPI

County of Trempealeau

Doing business as Hickory Ridge Adult Family Home

  • Adult Care Home Facility
  • Blair, WI
National Provider Identifier
1326170267
Registry record updated Apr 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Care Home FacilityTaxonomy code 311ZA0620X
License
11796 Issued in WI
Legal business name
COUNTY OF TREMPEALEAU
Doing business as
Hickory Ridge Adult Family Home
Practice address
W17306 Arneson Ridge Rd.
Blair, WI 54616
Phone
(608) 989-2018
NPI assigned
Mar 9, 2007
Last updated
Apr 15, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
COUNTY OF TREMPEALEAUAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 15, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jerru Deetz, N.H.A
Title
Executive Director
Phone
(715) 538-4312

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Care Home Facility 311ZA0620X 11796 WI Primary

Addresses

Primary practice location

W17306 Arneson Ridge Rd.
Blair, WI 54616

Mailing address

W20410 State Road 121
Whitehall, WI 54773-9147
Phone (715) 538-4312

Other identifiers 1

IdentifierTypeStateIssuer
11796OtherWIADULT FAMILY HOME

Other names 1

  • Hickory Ridge Adult Family Home Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20051205000776 WI Part B Supplier - Clinic/Group Practice 9133149156 Receives reassigned benefits from 6 practitioners
12 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Blair, WI; Whithall, WI; Whitehall, WI; Pigeon Falls, WI; Independence, WI

Other NPIs on the same Medicare enrollment 12

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
County of Trempealeau27 organizations share this tax ID, including this one
Part of
County of Trempealeau

Other organizations with this tax ID 26

Organizations that report the same tax identification number in the National Provider Directory.

View all 26

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173398400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1618444800000",
    "number": "1326170267",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "W20410 STATE ROAD 121",
            "city": "WHITEHALL",
            "state": "WI",
            "postal_code": "547739147",
            "telephone_number": "715-538-4312",
            "fax_number": "715-538-2426"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "W17306 ARNESON RIDGE RD.",
            "city": "BLAIR",
            "state": "WI",
            "postal_code": "54616",
            "telephone_number": "608-989-2018"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTY OF TREMPEALEAU",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COUNTY OF TREMPEALEAU",
        "enumeration_date": "2007-03-09",
        "last_updated": "2021-04-15",
        "certification_date": "2021-04-15",
        "status": "A",
        "authorized_official_last_name": "DEETZ",
        "authorized_official_first_name": "JERRU",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "715-538-4312",
        "authorized_official_credential": "N.H.A"
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "WI",
            "license": "11796",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ADULT FAMILY HOME",
            "identifier": "11796",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hickory Ridge Adult Family Home",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Hickory Ridge Adult Family Home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Blair, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.