Healthcare Provider Details

I. General information

NPI: 1649765736
Provider Name (Legal Business Name): NORDIC CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2018
Last Update Date: 06/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 OAK RIDGE DR STE D
EAU CLAIRE WI
54701-6257
US

IV. Provider business mailing address

1030 OAK RIDGE DR STE D
EAU CLAIRE WI
54701-6257
US

V. Phone/Fax

Practice location:
  • Phone: 715-598-8510
  • Fax: 715-598-8511
Mailing address:
  • Phone: 715-598-8510
  • Fax: 715-598-8511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number StateWI

VIII. Authorized Official

Name: MR. BRIAN KEITH WILSON
Title or Position: OWNER
Credential:
Phone: 715-559-5712