Organization Name: | FRED & MAMIE'S HOME, INC |
NPI Number: | 1740489558 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | SHARON ANN DEPEAU (PRESIDENT/OWNER) |
Mailing Address: | 143 School Creek Trl Luxemburg |
State: | WI US |
Postal Code: | 542171095 |
Phone Number: | 9208455950 |
Fax Number: | |
NPI Enumeration Date: | 07/12/2007 |
NPI Last Update Date: | 07/12/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 310400000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WI |
Taxonomy Type: | Nursing & Custodial Care Facilities |
Taxonomy Classification: | Assisted Living Facility |
Taxonomy Specialization: | |
Taxonomy Definition: | A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being. |