Provider Demographics
NPI:1982697132
Name:WISCONSIN HEALTH CARE FOUNDATION
Entity Type:Organization
Organization Name:WISCONSIN HEALTH CARE FOUNDATION
Other - Org Name:FOUNTAIN VIEW CARE CENTER LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:RICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-991-9072
Mailing Address - Street 1:1726 N BALLARD RD
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54911-2444
Mailing Address - Country:US
Mailing Address - Phone:920-991-9072
Mailing Address - Fax:920-749-4021
Practice Address - Street 1:50 WOLVERTON AVE
Practice Address - Street 2:
Practice Address - City:RIPON
Practice Address - State:WI
Practice Address - Zip Code:54971-1050
Practice Address - Country:US
Practice Address - Phone:920-748-5638
Practice Address - Fax:920-748-6427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-23
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3186314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI20189100Medicaid
WI525551Medicare Oscar/Certification