Provider Demographics
NPI:1437152204
Name:COUNTY OF WINNEBAGO
Entity Type:Organization
Organization Name:COUNTY OF WINNEBAGO
Other - Org Name:PARK VIEW HEALTH CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:FINANCIAL SERVICES MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:PETRASZAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-237-6910
Mailing Address - Street 1:725 BUTLER AVE
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54901-8149
Mailing Address - Country:US
Mailing Address - Phone:920-237-6300
Mailing Address - Fax:920-237-6940
Practice Address - Street 1:725 BUTLER AVE
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54901-8149
Practice Address - Country:US
Practice Address - Phone:920-237-6300
Practice Address - Fax:920-237-6940
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF WINNEBAGO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-05-24
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2436314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI20132800Medicaid
WI525638Medicare ID - Type Unspecified
WI525638Medicare UPIN