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General NPI Number Information
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NPI Number | 1366980724
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Entity Type | Organization
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Legal Business Name | OPPORTUNITY OF NORTH CENTRAL WISCONSIN, INC.
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Dates
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Enumeration Date | 02/06/2017
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Last Update Date | 02/06/2017
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Provider Practice Location Address
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Address Line | 1707 E WAUSAU AVE
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City | WAUSAU
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State | WI
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Zip | 54403-3137
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Country | US
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Telephone | 715-847-1175
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Fax | 715-849-3949
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Provider Business Mailing Address
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Address Line | 740 N 3RD ST
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City | WAUSAU
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State | WI
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Zip | 54403-4784
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Country | US
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Telephone | 715-842-8700
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Fax | 715-842-0922
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Authorized Official
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Title or Position | FINANCE MANAGER
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Name | MR. RODNEY C GUMZ
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Credential |
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Telephone | 715-842-8700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number | 8018163
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License Number State | WI
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