Provider Demographics
NPI:1215981998
Name:POLK COUNTY-DEPT OF ADMINISTRATION
Entity type:Organization
Organization Name:POLK COUNTY-DEPT OF ADMINISTRATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSING HOME ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DANA
Authorized Official - Middle Name:
Authorized Official - Last Name:REESE
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:715-268-7107
Mailing Address - Street 1:220 SCHOLL CT
Mailing Address - Street 2:
Mailing Address - City:AMERY
Mailing Address - State:WI
Mailing Address - Zip Code:54001-1440
Mailing Address - Country:US
Mailing Address - Phone:715-268-7107
Mailing Address - Fax:715-268-6167
Practice Address - Street 1:220 SCHOLL CT
Practice Address - Street 2:
Practice Address - City:AMERY
Practice Address - State:WI
Practice Address - Zip Code:54001-1440
Practice Address - Country:US
Practice Address - Phone:715-268-7107
Practice Address - Fax:715-268-6167
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:POLK COUNTY-DEPT OF ADMINISTRATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-19
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2376313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI20133000Medicaid
WI20133000Medicaid