Provider Demographics
NPI:1003819616
Name:TROUSDALE FOUNDATION, INC BENCHMARK HEALTHCARE OF DANE COUNTY
Entity Type:Organization
Organization Name:TROUSDALE FOUNDATION, INC BENCHMARK HEALTHCARE OF DANE COUNTY
Other - Org Name:HEARTLAND COUNTRY VILLAGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:C
Authorized Official - Last Name:HART
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:423-584-6755
Mailing Address - Street 1:634 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:BLACK EARTH
Mailing Address - State:WI
Mailing Address - Zip Code:53515-9544
Mailing Address - Country:US
Mailing Address - Phone:608-767-2572
Mailing Address - Fax:608-767-2565
Practice Address - Street 1:634 CENTER ST
Practice Address - Street 2:
Practice Address - City:BLACK EARTH
Practice Address - State:WI
Practice Address - Zip Code:53515-9544
Practice Address - Country:US
Practice Address - Phone:608-767-2572
Practice Address - Fax:608-767-2565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-27
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2944314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI20182900Medicaid
WI20182900Medicaid