Healthcare Provider Details

I. General information

NPI: 1083855753
Provider Name (Legal Business Name): WESTERN WISCONSIN CARES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2009
Last Update Date: 03/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1407 SAINT ANDREW ST
LA CROSSE WI
54603-3301
US

IV. Provider business mailing address

1407 SAINT ANDREW ST
LA CROSSE WI
54603-3301
US

V. Phone/Fax

Practice location:
  • Phone: 608-785-5968
  • Fax:
Mailing address:
  • Phone: 608-785-5968
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number State

VIII. Authorized Official

Name: KATIE E DNOHUE-NELSON
Title or Position: CASE MANAGER
Credential:
Phone: 608-785-5968