Healthcare Provider Details

I. General information

NPI: 1326579723
Provider Name (Legal Business Name): UCP OF WEST CENTRAL WISCONSIN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2017
Last Update Date: 03/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 WATER ST
EAU CLAIRE WI
54703-5699
US

IV. Provider business mailing address

206 WATER ST
EAU CLAIRE WI
54703-5699
US

V. Phone/Fax

Practice location:
  • Phone: 715-832-1782
  • Fax: 715-832-8203
Mailing address:
  • Phone: 715-832-1782
  • Fax: 715-832-8203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. TODD BREAKER
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 715-832-1782