Provider Demographics
NPI:1982015459
Name:THOUSAND HILLS HEALTHCARE, LLC
Entity Type:Organization
Organization Name:THOUSAND HILLS HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLEE
Authorized Official - Middle Name:
Authorized Official - Last Name:THILL
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:715-923-2500
Mailing Address - Street 1:N2359 SCHACHT RD
Mailing Address - Street 2:
Mailing Address - City:MARINETTE
Mailing Address - State:WI
Mailing Address - Zip Code:54143-9735
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:715-582-2940
Practice Address - Street 1:N2359 SCHACHT RD
Practice Address - Street 2:
Practice Address - City:MARINETTE
Practice Address - State:WI
Practice Address - Zip Code:54143-9735
Practice Address - Country:US
Practice Address - Phone:715-582-2940
Practice Address - Fax:715-582-2940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-18
Last Update Date:2014-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI29899-020207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIN41200003Medicaid
WI32295300Medicaid
MIN41200003Medicaid