Provider Demographics
NPI:1225535396
Name:SPRINGBROOK VILLAGE OF LA CRESCENT LLC
Entity Type:Organization
Organization Name:SPRINGBROOK VILLAGE OF LA CRESCENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPERTY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMONSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-598-7040
Mailing Address - Street 1:2850 MONARCH CT
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:WI
Mailing Address - Zip Code:54720-2642
Mailing Address - Country:US
Mailing Address - Phone:715-598-7040
Mailing Address - Fax:
Practice Address - Street 1:1384 COUNTY ROAD 25
Practice Address - Street 2:
Practice Address - City:LA CRESCENT
Practice Address - State:MN
Practice Address - Zip Code:55947
Practice Address - Country:US
Practice Address - Phone:507-551-2034
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-06
Last Update Date:2018-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility