NPI 1013915339
County of Wood
Practice location
- Address
- 1351 Wisconsin River Dr, Port Edwards, WI 54469-1041
- Phone
- (715) 885-8300
- Fax
- (715) 885-8351
- Mailing address
- 1351 Wisconsin River Dr, Port Edwards, WI 54469-1099
Authorised official
- Name
- Kyle Theiler
- Title
- Administrator
- Phone
- (715) 885-8324
Registered specialties
Skilled Nursing Facility
Primary
Registry record
- NPI
- 1013915339
- Entity type
- Organization
- NPI issued
- 11 Jul 2005
- Record last updated
- 9 Sep 2022
Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.