Provider Demographics
NPI:1790774107
Name:COUNTY OF GREEN
Entity Type:Organization
Organization Name:COUNTY OF GREEN
Other - Org Name:PLEASANT VIEW NURSING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DON
Authorized Official - Middle Name:M
Authorized Official - Last Name:STOOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-325-2171
Mailing Address - Street 1:N3150 HWY 81
Mailing Address - Street 2:P O BOX 768
Mailing Address - City:MONROE
Mailing Address - State:WI
Mailing Address - Zip Code:53566-9397
Mailing Address - Country:US
Mailing Address - Phone:608-325-2171
Mailing Address - Fax:608-325-1352
Practice Address - Street 1:N3150 HWY 81
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:WI
Practice Address - Zip Code:53566-9397
Practice Address - Country:US
Practice Address - Phone:608-325-2171
Practice Address - Fax:608-325-1352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2432314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI20138200Medicaid
525643Medicare ID - Type Unspecified