Provider Demographics
NPI:1518371244
Name:WHEATLAND MANAGEMENT
Entity Type:Organization
Organization Name:WHEATLAND MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:NUELLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-821-9539
Mailing Address - Street 1:155 34TH AVE. WEST
Mailing Address - Street 2:
Mailing Address - City:HAVRE
Mailing Address - State:MT
Mailing Address - Zip Code:59501
Mailing Address - Country:US
Mailing Address - Phone:217-342-4490
Mailing Address - Fax:
Practice Address - Street 1:700 N HENRIETTA ST
Practice Address - Street 2:
Practice Address - City:EFFINGHAM
Practice Address - State:IL
Practice Address - Zip Code:62401-1720
Practice Address - Country:US
Practice Address - Phone:217-821-9539
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-20
Last Update Date:2014-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT31471320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities