Provider Demographics
NPI:1073732251
Name:OUR HERITAGE FAMILY LIMITED
Entity Type:Organization
Organization Name:OUR HERITAGE FAMILY LIMITED
Other - Org Name:BIRCH CREEK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROXANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOREAU
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:920-964-3737
Mailing Address - Street 1:525 N 10TH ST
Mailing Address - Street 2:
Mailing Address - City:DE PERE
Mailing Address - State:WI
Mailing Address - Zip Code:54115-1403
Mailing Address - Country:US
Mailing Address - Phone:920-964-3737
Mailing Address - Fax:920-964-0614
Practice Address - Street 1:525 N 10TH ST
Practice Address - Street 2:
Practice Address - City:DE PERE
Practice Address - State:WI
Practice Address - Zip Code:54115-1403
Practice Address - Country:US
Practice Address - Phone:920-964-3737
Practice Address - Fax:920-964-0614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility