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State Of Wisconsin
Intellectual Disabilities Intermediate Care Facility in Union Grove, Wisconsin
NPI 1043326747

State Of Wisconsin is a Intellectual Disabilities Intermediate Care Facility based in Union Grove, WI. State Of Wisconsin practices in Union Grove, WI. The NPI Number for State Of Wisconsin is 1043326747 and holds a License No. 2763 (Wisconsin).

The current practice location address for State Of Wisconsin is 21425 Spring St, Union Grove, WI and can be reached out via phone at 262-878-2411 and via fax at 262-878-2922.

Location: 21425 Spring St, Union Grove, WI, 53182-9707
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1043326747
Provider Name
State Of Wisconsin
Credential
Provider Entity Type
Organization
Address
21425 Spring St, Union Grove, WI, 53182-9707
Phone Number
262-878-2411
Fax Number
262-878-2922
Provider Enumeration Date
08/22/2006
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
21050000 05 WI
institution
Provider Business Practice Location Address Details
Address
21425 Spring St
City
Union Grove
State
Wisconsin
Zip
53182-9707
Phone Number
262-878-2411
Fax Number
262-878-2922
person
Provider Business Mailing Address Details
Address
21425 Spring St
City
Union Grove
State
Wisconsin
Zip
53182-9707
Phone Number
262-878-2411
Fax Number
262-878-2922
person
Provider's Taxonomy Details 1
Type
Nursing & Custodial Care Facilities
Classification
Intermediate Care Facility, Mentally Retarded
Speciality
-
Taxonomy
315P00000X
License No.
2763 (Wisconsin)
Definition
(1) A public institution for care of the mentally retarded or people with related conditions. (2) An institution giving active treatment to mentally retarded or developmentally disabled persons or persons with related conditions. The primary purpose of the institution is to provide health or rehabilitative services to such individuals.
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