Healthcare Provider Details

I. General information

NPI: 1790309649
Provider Name (Legal Business Name): COUNTY OF PORTAGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2020
Last Update Date: 06/05/2020
Certification Date: 06/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1519 WATER STREET
STEVENS POINT WI
54481
US

IV. Provider business mailing address

1519 WATER STREET
STEVENS POINT WI
54481
US

V. Phone/Fax

Practice location:
  • Phone: 715-346-1401
  • Fax: 715-346-1418
Mailing address:
  • Phone: 715-346-1401
  • Fax: 715-346-1418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CYNTHIA L PIOTROWSKI
Title or Position: AGING & DISABILITY RESOURCE CENTER
Credential:
Phone: 715-346-1412