State of Wisconsin
State of Wisconsin is an Intellectual Disabilities Intermediate Care Facility in Union Grove, Wisconsin. Licensed in Wisconsin. Registered with an NPI since 2006.
- Licensed in
- WI
- In the registry since
- 2006
Practice location Address checks out
21425 Spring StUnion Grove, WI 53182-9707
Phone: (262) 878-2411
Fax: (262) 878-2922
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Pin is approximate — placed at the ZIP-code centre, not the exact door.
Specialties & licences
| Intellectual Disabilities Intermediate Care Facility (primary) | Taxonomy 315P00000X · Licence 2763 (WI) |
|---|
Record details
| NPI number | 1043326747 |
|---|---|
| Entity type | Organization (Type 2) |
| Organization subpart | No |
| Authorized official | James Hutchison — Nursing Home Administrator · (262) 878-2411 |
| Other names | Southern Wisconsin Center |
| NPI enumerated | August 22, 2006 |
| Last updated in NPPES | February 14, 2008 |
| Mailing address | 21425 Spring St, Union Grove, WI 53182-9707 |