Healthcare Provider Details

I. General information

NPI: 1669580908
Provider Name (Legal Business Name): HUMAN SERVICES BOARD SERVING NORTH CENTRAL HEALTH CARE FACILITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2006
Last Update Date: 10/19/2023
Certification Date: 10/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 MARSHALL ST STE B
WAUSAU WI
54403-6738
US

IV. Provider business mailing address

2400 MARSHALL ST STE A
WAUSAU WI
54403-6738
US

V. Phone/Fax

Practice location:
  • Phone: 715-848-4600
  • Fax:
Mailing address:
  • Phone: 715-848-4600
  • Fax: 715-845-5398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2931
License Number StateWI

VIII. Authorized Official

Name: GARY D. OLSEN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 715-848-4600