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General NPI Number Information
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NPI Number | 1326579723
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Entity Type | Organization
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Legal Business Name | UCP OF WEST CENTRAL WISCONSIN
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Dates
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Enumeration Date | 03/27/2017
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Last Update Date | 03/27/2017
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Provider Practice Location Address
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Address Line | 206 WATER ST
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City | EAU CLAIRE
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State | WI
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Zip | 54703-5699
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Country | US
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Telephone | 715-832-1782
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Fax | 715-832-8203
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Provider Business Mailing Address
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Address Line | 206 WATER ST
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City | EAU CLAIRE
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State | WI
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Zip | 54703-5699
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Country | US
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Telephone | 715-832-1782
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Fax | 715-832-8203
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. TODD BREAKER
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Credential |
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Telephone | 715-832-1782
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251X00000X
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Taxonomy Name | Supports Brokerage Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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