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St. Coletta Of Wisconsin
Intellectual Disabilities Intermediate Care Facility in Jefferson, Wisconsin
NPI 1871714543

St. Coletta Of Wisconsin is a Intellectual Disabilities Intermediate Care Facility based in Jefferson, WI. St. Coletta Of Wisconsin practices in Jefferson, WI. The NPI Number for St. Coletta Of Wisconsin is 1871714543 and holds a License No. 1109 (Wisconsin).

The current practice location address for St. Coletta Of Wisconsin is W4955 Us Highway 18, Jefferson, WI and can be reached out via phone at 920-674-4330 and via fax at 920-674-8422.

Location: W4955 Us Highway 18, Jefferson, WI, 53549-9702
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1871714543
Provider Name
St. Coletta Of Wisconsin
Credential
Provider Entity Type
Organization
Address
W4955 Us Highway 18, Jefferson, WI, 53549-9702
Phone Number
920-674-4330
Fax Number
920-674-8422
Provider Enumeration Date
05/01/2007
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
20009700 01 WI PROVIDER NUMBER
institution
Provider Business Practice Location Address Details
Address
W4955 Us Highway 18
City
Jefferson
State
Wisconsin
Zip
53549-9702
Phone Number
920-674-4330
Fax Number
920-674-8422
person
Provider Business Mailing Address Details
Address
W4955 Us Highway 18
City
Jefferson
State
Wisconsin
Zip
53549-9702
Phone Number
920-674-4330
Fax Number
920-674-8422
person
Provider's Taxonomy Details 1
Type
Nursing & Custodial Care Facilities
Classification
Intermediate Care Facility, Mentally Retarded
Speciality
-
Taxonomy
315P00000X
License No.
1109 (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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