Provider Demographics
NPI:1669467106
Name:SNOWHILL HEALTHCARE, LLC
Entity Type:Organization
Organization Name:SNOWHILL HEALTHCARE, LLC
Other - Org Name:WISSOTA HEALTH & REGIONAL VENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOYD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-723-9341
Mailing Address - Street 1:7490 156TH ST
Mailing Address - Street 2:
Mailing Address - City:CHIPPEWA FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54729-1425
Mailing Address - Country:US
Mailing Address - Phone:715-723-9341
Mailing Address - Fax:715-723-0263
Practice Address - Street 1:7490 156TH ST
Practice Address - Street 2:
Practice Address - City:CHIPPEWA FALLS
Practice Address - State:WI
Practice Address - Zip Code:54729-1425
Practice Address - Country:US
Practice Address - Phone:715-723-9341
Practice Address - Fax:715-723-0263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3168314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI20195900Medicaid
WI525379Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER