Provider Demographics
NPI:1790771368
Name:HEYDE HEALTH SYSTEM, INC
Entity Type:Organization
Organization Name:HEYDE HEALTH SYSTEM, INC
Other - Org Name:EAGLETON HOME FDD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:L
Authorized Official - Last Name:HEYDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-726-9094
Mailing Address - Street 1:345 FRENETTE DR
Mailing Address - Street 2:
Mailing Address - City:CHIPPEWA FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54729-3372
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14135 150TH AVE
Practice Address - Street 2:
Practice Address - City:BLOOMER
Practice Address - State:WI
Practice Address - Zip Code:54724-4410
Practice Address - Country:US
Practice Address - Phone:715-288-6311
Practice Address - Fax:715-288-6312
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2970315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI20163600Medicaid