Provider Demographics
NPI:1558715714
Name:ESH ENTERPRISES LLC
Entity Type:Organization
Organization Name:ESH ENTERPRISES LLC
Other - Org Name:SWIFTHAVEN COMMUNITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:E
Authorized Official - Last Name:SIMONSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-598-7040
Mailing Address - Street 1:2850 MONARCH CT
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:WI
Mailing Address - Zip Code:54720-2642
Mailing Address - Country:US
Mailing Address - Phone:715-598-7040
Mailing Address - Fax:715-598-7042
Practice Address - Street 1:124 N HENRY ST
Practice Address - Street 2:
Practice Address - City:EDGERTON
Practice Address - State:WI
Practice Address - Zip Code:53534-1868
Practice Address - Country:US
Practice Address - Phone:608-884-2828
Practice Address - Fax:608-884-2820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-14
Last Update Date:2016-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI0013881320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities