Provider Demographics
NPI:1326438557
Name:OSSEO HEALTHCARE, LLC
Entity Type:Organization
Organization Name:OSSEO HEALTHCARE, LLC
Other - Org Name:DOVE HEALTHCARE- OSSEO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:TOMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-227-5957
Mailing Address - Street 1:51019 RIDGEVIEW RD
Mailing Address - Street 2:
Mailing Address - City:OSSEO
Mailing Address - State:WI
Mailing Address - Zip Code:54758-2606
Mailing Address - Country:US
Mailing Address - Phone:715-597-2493
Mailing Address - Fax:
Practice Address - Street 1:51019 RIDGEVIEW RD
Practice Address - Street 2:
Practice Address - City:OSSEO
Practice Address - State:WI
Practice Address - Zip Code:54758-2606
Practice Address - Country:US
Practice Address - Phone:715-597-2493
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-26
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility