Provider Demographics
NPI:1811590557
Name:STOUGHTON MEADOWS ASSISTED LIVING FACILITY
Entity Type:Organization
Organization Name:STOUGHTON MEADOWS ASSISTED LIVING FACILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:WELLNESS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HARLEY
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:PAULSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-877-1227
Mailing Address - Street 1:2321 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:STOUGHTON
Mailing Address - State:WI
Mailing Address - Zip Code:53589-5405
Mailing Address - Country:US
Mailing Address - Phone:608-877-1227
Mailing Address - Fax:608-877-1241
Practice Address - Street 1:2321 JACKSON ST
Practice Address - Street 2:
Practice Address - City:STOUGHTON
Practice Address - State:WI
Practice Address - Zip Code:53589-5405
Practice Address - Country:US
Practice Address - Phone:608-877-1227
Practice Address - Fax:608-877-1241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility