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General NPI Number Information
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NPI Number | 1639187412
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Entity Type | Organization
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Legal Business Name | LANGLADE HOSPITAL - HOTEL DIEU OF ST. JOSEPH OF ANTIGO WISCONSIN
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Dates
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Enumeration Date | 08/04/2006
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Last Update Date | 10/23/2025
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Provider Practice Location Address
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Address Line | 112 E 5TH AVE
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City | ANTIGO
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State | WI
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Zip | 54409-2710
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Country | US
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Telephone | 715-623-2331
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Fax |
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Provider Business Mailing Address
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Address Line | 29980 NETWORK PL
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City | CHICAGO
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State | IL
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Zip | 60673-1299
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Country | US
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Telephone | 715-847-2304
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Fax | 715-843-1188
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Authorized Official
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Title or Position | SVP & CHIEF FINANCIAL OFFICER
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Name | JERRY M YANG
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Credential |
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Telephone | 715-847-2526
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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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 | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 282NC0060X
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Taxonomy Name | Critical Access Hospital
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License Number | 1055
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License Number State | WI
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