Organization · Type 2 NPI
St. Coletta of Wisconsin
Intellectual Disabilities Intermediate Care Facility · Jefferson, WI
NPI number
1871714543
Active
Practice location
W4955 US Highway 18
Jefferson, WI 53549-9702
Fax (920) 674-8422
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Intellectual Disabilities Intermediate Care Facility Primary | 315P00000X | 1109 (WI) |
Intellectual Disabilities Intermediate Care Facility: An intermediate care facility providing services for individuals with intellectual disabilities.
About NPI 1871714543
St. Coletta of Wisconsin's National Provider Identifier is 1871714543, issued on May 1, 2007. The primary taxonomy on file is Intellectual Disabilities Intermediate Care Facility (315P00000X), and the practice location is in Jefferson, WI. The record was last updated on Aug 22, 2020.