Provider Demographics
NPI:1609876655
Name:ARIZCONSIN GROUP INC
Entity Type:Organization
Organization Name:ARIZCONSIN GROUP INC
Other - Org Name:CRANDON NURSING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:I
Authorized Official - Last Name:RAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-478-3324
Mailing Address - Street 1:PO BOX 400
Mailing Address - Street 2:
Mailing Address - City:CRANDON
Mailing Address - State:WI
Mailing Address - Zip Code:54520-0400
Mailing Address - Country:US
Mailing Address - Phone:715-478-3324
Mailing Address - Fax:715-478-5085
Practice Address - Street 1:105 W PIONEER ST
Practice Address - Street 2:
Practice Address - City:CRANDON
Practice Address - State:WI
Practice Address - Zip Code:54520-1554
Practice Address - Country:US
Practice Address - Phone:715-478-3324
Practice Address - Fax:715-478-5085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-29
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2945314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI20124900Medicaid
WI2945OtherFACIOLITY LICENSE NUMBER
WI20124900Medicaid