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General NPI Number Information
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NPI Number | 1003271180
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Entity Type | Organization
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Legal Business Name | CHURCH HEALTH SERVICES
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Dates
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Enumeration Date | 12/16/2015
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Last Update Date | 12/16/2015
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Provider Practice Location Address
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Address Line | 115 N CENTER ST
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City | BEAVER DAM
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State | WI
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Zip | 53916-2119
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Country | US
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Telephone | 920-887-1766
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Fax | 920-887-2322
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Provider Business Mailing Address
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Address Line | 115 N CENTER ST
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City | BEAVER DAM
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State | WI
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Zip | 53916-2119
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Country | US
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Telephone | 920-887-1766
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Fax | 920-887-2322
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | SUSAN OSTEEN
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Credential |
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Telephone | 920-887-1766
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 3106
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License Number State | WI
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