STATE OF WISCONSIN is an intermediate care facility mentally retarded in Union Grove, WI. The provider is an intermediate care facility providing services for individuals with intellectual disabilities. STATE OF WISCONSIN NPI is 1043326747. The provider is registered as an organization entity type.
The provider Is Doing Business As Southern Wisconsin Center.
The provider's business location address is:
21425 SPRING ST
UNION GROVE, WI
ZIP 53182-707
Phone: (262) 878-2411
Fax: (262) 878-2922
The provider's authorized official is James E Hutchison .
The authorized official title is Nursing Home Administrator and has the following contact phone number (262) 878-2411.
The CLIA number assigned to this NPI record is 52D0879904 - intermediate care facility for mentally retarded with a certificate type of Certificate of Waiver.
The enumeration date for this NPI number is 8/22/2006 and was last updated on 2/14/2008.