Healthcare Provider Details

I. General information

NPI: 1942666763
Provider Name (Legal Business Name): OAK PARK PLACE OF BARABOO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2016
Last Update Date: 01/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 WALDO ST
BARABOO WI
53913-2893
US

IV. Provider business mailing address

719 JUPITER DR
MADISON WI
53718-2984
US

V. Phone/Fax

Practice location:
  • Phone: 608-355-4111
  • Fax:
Mailing address:
  • Phone: 608-663-8600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: SCOTT FRANK
Title or Position: CEO
Credential:
Phone: 608-663-8728