Provider Demographics
NPI:1417214651
Name:HEYDE HEALTH SYSTEM PEPIN LLC
Entity Type:Organization
Organization Name:HEYDE HEALTH SYSTEM PEPIN LLC
Other - Org Name:LAKEVIEW RESIDENCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT/COO
Authorized Official - Prefix:
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:C
Authorized Official - Last Name:METTEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-726-9094
Mailing Address - Street 1:345 FRENETTE DR
Mailing Address - Street 2:
Mailing Address - City:CHIPPEWA FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54729-3372
Mailing Address - Country:US
Mailing Address - Phone:715-726-9094
Mailing Address - Fax:715-723-1205
Practice Address - Street 1:1112 SECOND ST.
Practice Address - Street 2:
Practice Address - City:PEPIN
Practice Address - State:WI
Practice Address - Zip Code:54759-9658
Practice Address - Country:US
Practice Address - Phone:715-442-4811
Practice Address - Fax:715-442-2904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-12
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13844310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI13844OtherWISCONSIN DEPARTMENT OF HEALTH SERVICES