Provider Demographics
NPI:1013792597
Name:RASCALS RESORT LLC
Entity Type:Organization
Organization Name:RASCALS RESORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE BOARD MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MISSY
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDREWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-548-5006
Mailing Address - Street 1:W10000 STATE ROAD 82
Mailing Address - Street 2:
Mailing Address - City:ELROY
Mailing Address - State:WI
Mailing Address - Zip Code:53929-9454
Mailing Address - Country:US
Mailing Address - Phone:608-548-5006
Mailing Address - Fax:
Practice Address - Street 1:29429 COUNTY HIGHWAY V
Practice Address - Street 2:
Practice Address - City:KENDALL
Practice Address - State:WI
Practice Address - Zip Code:54638-8518
Practice Address - Country:US
Practice Address - Phone:608-463-7377
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-31
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities