Provider Demographics
NPI:1649571787
Name:MARSH COUNTRY HEALTH ALLIANCE
Entity Type:Organization
Organization Name:MARSH COUNTRY HEALTH ALLIANCE
Other - Org Name:MCHA NORTH
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JANE
Authorized Official - Middle Name:E
Authorized Official - Last Name:HOOPER
Authorized Official - Suffix:
Authorized Official - Credentials:NHA RN
Authorized Official - Phone:920-386-3409
Mailing Address - Street 1:199 HOME ROAD
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:WI
Mailing Address - Zip Code:53039-1402
Mailing Address - Country:US
Mailing Address - Phone:920-386-3400
Mailing Address - Fax:920-386-3800
Practice Address - Street 1:199 HOME RD
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:WI
Practice Address - Zip Code:53039-1402
Practice Address - Country:US
Practice Address - Phone:920-386-3400
Practice Address - Fax:920-386-3800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-05
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI20145400Medicaid
WI525453Medicare Oscar/Certification