Provider Demographics
NPI:1831101864
Name:COUNTY OF COLUMBIA
Entity type:Organization
Organization Name:COUNTY OF COLUMBIA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:NURSING HOME ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:E
Authorized Official - Last Name:YAMRISKA
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:608-429-2181
Mailing Address - Street 1:323 W. MONROE ST.
Mailing Address - Street 2:P.O. BOX 895
Mailing Address - City:WYOCENA
Mailing Address - State:WI
Mailing Address - Zip Code:53969
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:608-429-2607
Practice Address - Street 1:323 W. MONROE ST.
Practice Address - Street 2:
Practice Address - City:WYOCENA
Practice Address - State:WI
Practice Address - Zip Code:53969
Practice Address - Country:US
Practice Address - Phone:608-429-2181
Practice Address - Fax:608-429-2607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2418314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI20134300Medicaid
WI20134300Medicaid
WI0513150001Medicare NSC