Healthcare Provider Details

I. General information

NPI: 1679785182
Provider Name (Legal Business Name): NEW HOPE CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 WEST RAILROAD AVE.
ST. CLOUD WI
53079
US

IV. Provider business mailing address

443 MANHATTAN STREET P.O. BOX 189
CHILTON WI
53014-1565
US

V. Phone/Fax

Practice location:
  • Phone: 920-999-3033
  • Fax:
Mailing address:
  • Phone: 920-849-9351
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number3173-026
License Number StateWI

VIII. Authorized Official

Name: MRS. KELLY MARIE DAVIES
Title or Position: OCCUPATIONAL THERAPIST
Credential: OTR
Phone: 920-849-9351