Healthcare Provider Details

I. General information

NPI: 1043183155
Provider Name (Legal Business Name): CHIPPEWA VALLEY CARE HOMES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2025
Last Update Date: 09/25/2025
Certification Date: 09/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3319 MILLER ST
EAU CLAIRE WI
54701-7647
US

IV. Provider business mailing address

3319 MILLER ST
EAU CLAIRE WI
54701-7647
US

V. Phone/Fax

Practice location:
  • Phone: 612-426-9947
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. KAMAL A MOHAMED
Title or Position: PRESIDENT
Credential:
Phone: 612-426-9947