Healthcare Provider Details

I. General information

NPI: 1295980332
Provider Name (Legal Business Name): WHEELS OF INDEPENDENCE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2008
Last Update Date: 11/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2703 INDUSTRIAL ST
WISCONSIN RAPIDS WI
54495-2229
US

IV. Provider business mailing address

2703 INDUSTRIAL ST
WISCONSIN RAPIDS WI
54495-2229
US

V. Phone/Fax

Practice location:
  • Phone: 715-423-7818
  • Fax: 715-423-8283
Mailing address:
  • Phone: 715-423-7818
  • Fax: 715-423-8283

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code344600000X
TaxonomyTaxi
License Number2438-800
License Number StateWI

VIII. Authorized Official

Name: MR. JIM W BROWN
Title or Position: FISCAL MANAGER
Credential:
Phone: 715-423-7818