Provider Demographics
NPI:1023006814
Name:REEDSBURG AREA SENIOR LIFE CENTER INC
Entity Type:Organization
Organization Name:REEDSBURG AREA SENIOR LIFE CENTER INC
Other - Org Name:EDWARD SNYDER MEMORIAL NURSING HOME
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:VP SENIOR SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-768-5805
Mailing Address - Street 1:2350 N DEWEY AVE
Mailing Address - Street 2:
Mailing Address - City:REEDSBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53959
Mailing Address - Country:US
Mailing Address - Phone:608-524-6577
Mailing Address - Fax:608-524-0757
Practice Address - Street 1:2350 N DEWEY AVE
Practice Address - Street 2:
Practice Address - City:REEDSBURG
Practice Address - State:WI
Practice Address - Zip Code:53959
Practice Address - Country:US
Practice Address - Phone:608-524-6577
Practice Address - Fax:608-524-0757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-06
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2297314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI20195700Medicaid
WI20195700Medicaid