Provider Demographics
NPI:1750305520
Name:WASHINGTON COUNTY WISCONSIN
Entity Type:Organization
Organization Name:WASHINGTON COUNTY WISCONSIN
Other - Org Name:SAMARITANS CEDAR CROSSING SUB-ACUTE UNIT
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:SOMERS
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:262-335-4500
Mailing Address - Street 1:531 E WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:WEST BEND
Mailing Address - State:WI
Mailing Address - Zip Code:53095-2531
Mailing Address - Country:US
Mailing Address - Phone:262-335-4500
Mailing Address - Fax:262-335-4699
Practice Address - Street 1:3200 PLEASANT VALLEY RD
Practice Address - Street 2:
Practice Address - City:WEST BEND
Practice Address - State:WI
Practice Address - Zip Code:53095-9274
Practice Address - Country:US
Practice Address - Phone:262-707-6800
Practice Address - Fax:262-707-6801
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WASHINGTON COUNTY WISCONSIN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-26
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3192314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI525618Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER