NPI 1366440430 · live from the CMS NPI Registry
Ccg - Frederic
Skilled Nursing Facility in Frederic, WI. National Provider Identifier 1366440430, active.
NPI record
| NPI | 1366440430 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Skilled Nursing Facility 314000000X |
| Practice location | 205 United Way, Frederic, WI 54837 |
| Practice phone | 715-327-4297 |
| Mailing address | 5000 Hakes Dr, Suite 600, Norton Shores, MI 49441 |
| Enumerated | July 12, 2005 |
| Last updated | April 20, 2008 |
| Authorized official | Keith Yoder, Cfo |
| Other names | Frederic Nursing And Rehabilitation Community |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Skilled Nursing Facility primary | 314000000X | 3086 (WI) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.