Healthcare Provider Details

I. General information

NPI: 1003819491
Provider Name (Legal Business Name): COUNTY OF PORTAGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 02/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 WHITING AVE
STEVENS POINT WI
54481-5246
US

IV. Provider business mailing address

825 WHITING AVE
STEVENS POINT WI
54481-5246
US

V. Phone/Fax

Practice location:
  • Phone: 715-346-1375
  • Fax: 715-346-1628
Mailing address:
  • Phone: 715-346-1375
  • Fax: 715-346-1628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2394
License Number StateWI

VIII. Authorized Official

Name: MARCIA MCDONALD
Title or Position: ADMINISTRATOR
Credential:
Phone: 715-346-1497