Healthcare Provider Details

I. General information

NPI: 1003065574
Provider Name (Legal Business Name): COMMUNITY HEALTH RESOURCES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2008
Last Update Date: 09/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1133 4TH AVE S
PARK FALLS WI
54552-1922
US

IV. Provider business mailing address

PO BOX 110 1133 S. 4TH AVENUE
PARK FALLS WI
54552-0110
US

V. Phone/Fax

Practice location:
  • Phone: 715-762-4600
  • Fax: 715-762-2835
Mailing address:
  • Phone: 715-762-4600
  • Fax: 715-762-2835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number41868100
License Number StateWI

VIII. Authorized Official

Name: MS. JANE A NOVITZKE
Title or Position: ADMINISTRATOR
Credential: ARNP-BC
Phone: 715-762-4600