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General NPI Number Information
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NPI Number | 1841706942
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Entity Type | Organization
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Legal Business Name | NORMIC ENTERPRISES INC
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Dates
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Enumeration Date | 12/27/2017
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Last Update Date | 12/27/2017
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Provider Practice Location Address
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Address Line | N8761 OVERLAND DR
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City | WATERTOWN
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State | WI
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Zip | 53094-9592
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Country | US
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Telephone | 414-962-7773
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Fax | 920-355-0175
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Provider Business Mailing Address
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Address Line | N248 COUNTY ROAD P
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City | OCONOMOWOC
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State | WI
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Zip | 53066-9506
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Country | US
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Telephone | 414-962-7773
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MR. JEFFREY CARL FREMDER
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Credential |
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Telephone | 414-962-7773
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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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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