Provider Demographics
NPI:1801892435
Name:FIRST AMERICAN ENTERPRISES, INC
Entity type:Organization
Organization Name:FIRST AMERICAN ENTERPRISES, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DARLENE
Authorized Official - Middle Name:A
Authorized Official - Last Name:DENUCCI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-234-2161
Mailing Address - Street 1:19 WEST NEWTON ST
Mailing Address - Street 2:
Mailing Address - City:RICE LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:54868-1744
Mailing Address - Country:US
Mailing Address - Phone:715-234-2161
Mailing Address - Fax:715-234-1705
Practice Address - Street 1:19 WEST NEWTON ST
Practice Address - Street 2:
Practice Address - City:RICE LAKE
Practice Address - State:WI
Practice Address - Zip Code:54868-1744
Practice Address - Country:US
Practice Address - Phone:715-234-2161
Practice Address - Fax:715-234-1705
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FIRST AMERICAN ENTERPRISES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-06-28
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2463314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI20156200Medicaid
WI525374Medicare Oscar/Certification