Provider Demographics
NPI:1558409227
Name:COUNTRYVIEW GROUP HOMES LLC
Entity Type:Organization
Organization Name:COUNTRYVIEW GROUP HOMES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:
Authorized Official - Last Name:KANTROWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-243-5515
Mailing Address - Street 1:1538 W LIEBAU RD
Mailing Address - Street 2:
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53092-2621
Mailing Address - Country:US
Mailing Address - Phone:262-243-5515
Mailing Address - Fax:262-243-5516
Practice Address - Street 1:N112W12850 MEQUON RD
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:WI
Practice Address - Zip Code:53022-3624
Practice Address - Country:US
Practice Address - Phone:262-512-1177
Practice Address - Fax:262-512-9404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI177F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes177F00000XOther Service ProvidersLodgingGroup - Multi-Specialty