Organization · Type 2 NPI

County of Trempealeau

Adult Care Home Facility · Blair, WI

NPI number 1326170267 Active

Practice location

W17306 Arneson Ridge Rd.
Blair, WI 54616

Call (608) 989-2018 Map

Mailing address

W20410 State Road 121
Whitehall, WI 54773-9147

Specialties and licenses

Taxonomy	Code	License
Adult Care Home Facility Primary	311ZA0620X	11796 (WI)

Adult Care Home Facility: A custodial care facility providing supportive and personal care services to disabled and/or elderly individuals who cannot function independently in most areas of activity and need assistance and monitoring to enable them to remain in a home like environment.

NPI record

NPI: 1326170267
Entity type: Organization (Type 2)
Issued: Mar 9, 2007
Last updated: Apr 15, 2021
Status: Active
Subpart: Yes of County of Trempealeau

Other names

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Hickory Ridge Adult Family Home · doing business as
Hickory Ridge Adult Family Home · doing business as

Authorized official

Jerru Deetz, N.H.A
Executive Director
(715) 538-4312

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This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1326170267

County of Trempealeau's National Provider Identifier is 1326170267, issued on Mar 9, 2007. The primary taxonomy on file is Adult Care Home Facility (311ZA0620X), and the practice location is in Blair, WI. The record was last updated on Apr 15, 2021.