NPI 1336505791

1311 Tyler Street Operating Company, LLC

Organisation Skilled Nursing Facility Black River Falls, WI

Practice location

Address: 1311 Tyler St, Black River Falls, WI 54615-1564
Phone: (715) 284-4396
Fax: (715) 284-9580
Mailing address: 1726 N Ballard Rd, Appleton, WI 54911-2444

Authorised official

Name: Kevin P Breslin
Title: Manager
Phone: (973) 339-8892

Registered specialties

Skilled Nursing Facility Primary

Nursing & Custodial Care Facilities Taxonomy 314000000X Licence 3211 (WI)

Other Skilled Nursing Facility providers in Wisconsin →

Registry record

NPI: 1336505791
Entity type: Organization
NPI issued: 14 Jan 2016
Record last updated: 5 Apr 2016

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.