Provider Demographics
NPI:1013678770
Name:COUNTY OF LA CROSSE
Entity Type:Organization
Organization Name:COUNTY OF LA CROSSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSING HOME ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:KRAMER
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:608-519-9357
Mailing Address - Street 1:3501 PARK LANE DR
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-7747
Mailing Address - Country:US
Mailing Address - Phone:608-789-4800
Mailing Address - Fax:
Practice Address - Street 1:3501 PARK LANE DR
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601-7747
Practice Address - Country:US
Practice Address - Phone:608-789-4800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF LA CROSSE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-01-05
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310500000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI20128700Medicaid