Healthcare Provider Details

I. General information

NPI: 1245487065
Provider Name (Legal Business Name): NORTHWOODS INC OF WISCONSIN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2008
Last Update Date: 08/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

N6510 US HIGHWAY 51
PORTAGE WI
53901-9603
US

IV. Provider business mailing address

N6510 US HIGHWAY 51 PO BOX 357
PORTAGE WI
53901-9603
US

V. Phone/Fax

Practice location:
  • Phone: 608-742-7114
  • Fax: 608-742-0636
Mailing address:
  • Phone: 608-742-7114
  • Fax: 608-742-0636

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
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 TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. JEFFREY H AERTS
Title or Position: PRESIDENT AND CEO
Credential:
Phone: 608-742-7114