Provider Demographics
NPI:1467410670
Name:COUNTY OF TREMPEALEAU
Entity Type:Organization
Organization Name:COUNTY OF TREMPEALEAU
Other - Org Name:TCHCC PFHCC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JERRU
Authorized Official - Middle Name:
Authorized Official - Last Name:DEETZ
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:715-538-4312
Mailing Address - Street 1:W20410 STATE ROAD 121
Mailing Address - Street 2:
Mailing Address - City:WHITEHALL
Mailing Address - State:WI
Mailing Address - Zip Code:54773-9147
Mailing Address - Country:US
Mailing Address - Phone:715-538-4312
Mailing Address - Fax:715-538-2426
Practice Address - Street 1:13197 CHURCH STREET
Practice Address - Street 2:
Practice Address - City:PIGEON FALLS
Practice Address - State:WI
Practice Address - Zip Code:54760-9685
Practice Address - Country:US
Practice Address - Phone:715-538-4312
Practice Address - Fax:715-983-5700
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF TREMPEALEAU
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-04
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3228314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI20180000Medicaid
WI20180000Medicaid
WI000062045Medicare PIN