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General NPI Number Information
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NPI Number | 1144325267
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Entity Type | Organization
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Legal Business Name | BROWN COUNTY HEALTH CARE CENTER BAYVIEW DEVELPMENTAL CENTER
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Dates
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Enumeration Date | 09/13/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2900 SAINT ANTHONY DR
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City | GREEN BAY
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State | WI
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Zip | 54311-5859
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Country | US
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Telephone | 920-391-4700
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Fax | 920-391-4870
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Provider Business Mailing Address
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Address Line | 2900 SAINT ANTHONY DR
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City | GREEN BAY
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State | WI
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Zip | 54311-5859
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Country | US
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Telephone | 920-391-4700
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Fax | 920-391-4870
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Authorized Official
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Title or Position | INPATIENT SERVICES DIRECTOR
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Name | MS. DIANE PIVONKA
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Credential | RN, MS, APNP, NHA
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Telephone | 920-391-4700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number | 2986
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License Number State | WI
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