Healthcare Provider Details

I. General information

NPI: 1932021615
Provider Name (Legal Business Name): CEDAR SPRINGS THERAPEUTIC RANCH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3128 SLINGER RD
SLINGER WI
53086-9727
US

IV. Provider business mailing address

PO BOX 625
SLINGER WI
53086-0625
US

V. Phone/Fax

Practice location:
  • Phone: 262-345-2163
  • Fax:
Mailing address:
  • Phone: 262-345-2163
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name: DANIELLE MISSALL
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 262-345-2163