Provider Demographics
NPI:1447244108
Name:MULDER HEALTH CARE FACILITY, INC
Entity Type:Organization
Organization Name:MULDER HEALTH CARE FACILITY, INC
Other - Org Name:MULDER NURSING HOME
Other - Org Type:Other Name
Authorized Official - Title/Position:NURSING HOME ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:GENE
Authorized Official - Last Name:GILBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:NURSING HOME ADMINIS
Authorized Official - Phone:608-786-1600
Mailing Address - Street 1:713 N LEONARD ST
Mailing Address - Street 2:PO BOX 850
Mailing Address - City:WEST SALEM
Mailing Address - State:WI
Mailing Address - Zip Code:54669-0850
Mailing Address - Country:US
Mailing Address - Phone:608-786-1600
Mailing Address - Fax:608-786-0740
Practice Address - Street 1:713 N LEONARD ST
Practice Address - Street 2:
Practice Address - City:WEST SALEM
Practice Address - State:WI
Practice Address - Zip Code:54669-0850
Practice Address - Country:US
Practice Address - Phone:608-786-1600
Practice Address - Fax:608-786-0740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1031314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI20137200Medicaid
WI20137200Medicaid