NPIMap

Organization Active NPI

County of Trempealeau

Doing business as Clover Way RCAC

  • Assisted Living Facility (Mental Illness)
  • Independence, WI
National Provider Identifier
1952541013
Registry record updated Apr 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living Facility (Mental Illness)Taxonomy code 3104A0625X
License
12483 Issued in WI
Legal business name
COUNTY OF TREMPEALEAU
Doing business as
Clover Way RCAC
Practice address
36125 E End Rd
Independence, WI 54747-8080
Phone
(715) 985-2270
NPI assigned
Mar 3, 2009
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
Jerry Deetz, N.H.A.
Title
Executive Director
Phone
(715) 538-4312

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility (Mental Illness) 3104A0625X 12483 WI Primary

Addresses

Primary practice location

36125 E End Rd
Independence, WI 54747-8080

Mailing address

W20410 State Road 121
Whitehall, WI 54773-9147

Other identifiers 1

IdentifierTypeStateIssuer
12483MedicaidWI

Other names 1

  • Clover Way RCAC Doing business as

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.

NPI Registry JSON

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

{
    "created_epoch": "1236038400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1618444800000",
    "number": "1952541013",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "36125 E END RD",
            "city": "INDEPENDENCE",
            "state": "WI",
            "postal_code": "547478080",
            "telephone_number": "715-985-2270"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTY OF TREMPEALEAU",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COUNTY OF TREMPEALEAU",
        "enumeration_date": "2009-03-03",
        "last_updated": "2021-04-15",
        "certification_date": "2021-04-15",
        "status": "A",
        "authorized_official_last_name": "DEETZ",
        "authorized_official_first_name": "JERRY",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "715-538-4312",
        "authorized_official_credential": "N.H.A."
    },
    "taxonomies": [
        {
            "code": "3104A0625X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Mental Illness",
            "state": "WI",
            "license": "12483",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "12483",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Clover Way RCAC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Clover Way RCAC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Independence, 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.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.