NPIMap

Organization Active NPI

Heyde Health System, Inc

Doing business as Eagleton Home FDD

  • Intellectual Disabilities Intermediate Care Facility
  • Bloomer, WI
National Provider Identifier
1790771368
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
License
2970 Issued in WI
Legal business name
HEYDE HEALTH SYSTEM, INC
Doing business as
Eagleton Home FDD
Practice address
14135 150TH Ave
Bloomer, WI 54724-4410
Phone
(715) 288-6311
Fax
(715) 288-6312
NPI assigned
Sep 20, 2005
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. Dennis L Heyde
Title
President
Phone
(715) 726-9094

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X 2970 WI Primary

Addresses

Primary practice location

14135 150TH Ave
Bloomer, WI 54724-4410

Mailing address

345 Frenette Dr
Chippewa Falls, WI 54729-3372

Other identifiers 1

IdentifierTypeStateIssuer
20163600MedicaidWI

Other names 1

  • Eagleton Home FDD Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Heyde Health System Inc4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

NPI Registry JSON

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

{
    "created_epoch": "1127174400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1790771368",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "345 FRENETTE DR",
            "city": "CHIPPEWA FALLS",
            "state": "WI",
            "postal_code": "547293372"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14135 150TH AVE",
            "city": "BLOOMER",
            "state": "WI",
            "postal_code": "547244410",
            "telephone_number": "715-288-6311",
            "fax_number": "715-288-6312"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEYDE HEALTH SYSTEM, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-20",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HEYDE",
        "authorized_official_first_name": "DENNIS",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "715-726-9094",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "WI",
            "license": "2970",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "20163600",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eagleton Home FDD",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bloomer, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.