Healthcare Provider Details

I. General information

NPI: 1184922643
Provider Name (Legal Business Name): OUR WAY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2011
Last Update Date: 03/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 CHARLES AVE
TOMAHAWK WI
54487-1832
US

IV. Provider business mailing address

825 CHARLES AVE PO BOX 76
TOMAHAWK WI
54487-1832
US

V. Phone/Fax

Practice location:
  • Phone: 715-453-7555
  • Fax: 715-453-7444
Mailing address:
  • Phone: 715-453-7555
  • Fax: 715-453-7444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: SUSAN HAWKINS
Title or Position: ADMINISTRATOR
Credential:
Phone: 715-453-7555