Healthcare Provider Details

I. General information

NPI: 1770908667
Provider Name (Legal Business Name): OPPORTUNITY OF NORTH CENTRAL WISCONSIN, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2014
Last Update Date: 02/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 N 3RD ST
WAUSAU WI
54403-4784
US

IV. Provider business mailing address

740 N 3RD ST
WAUSAU WI
54403-4784
US

V. Phone/Fax

Practice location:
  • Phone: 715-842-8700
  • Fax: 715-848-3511
Mailing address:
  • Phone: 715-842-8700
  • Fax: 715-848-3511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MR. JON POTTER
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 715-842-8700