Provider Demographics
NPI:1851522767
Name:MISSISSIPPI VALLEY HEALTH SERVICES COMMISSION
Entity Type:Organization
Organization Name:MISSISSIPPI VALLEY HEALTH SERVICES COMMISSION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:PLACHECKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-786-1400
Mailing Address - Street 1:962 GARLAND ST E
Mailing Address - Street 2:
Mailing Address - City:WEST SALEM
Mailing Address - State:WI
Mailing Address - Zip Code:54669-1308
Mailing Address - Country:US
Mailing Address - Phone:608-786-1400
Mailing Address - Fax:
Practice Address - Street 1:962 GARLAND ST E
Practice Address - Street 2:
Practice Address - City:WEST SALEM
Practice Address - State:WI
Practice Address - Zip Code:54669-1308
Practice Address - Country:US
Practice Address - Phone:608-786-1400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-28
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2395314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI2395OtherDEPT OF HEALTH SERVICES, DIV OF QUALITY ASSURANCE