MEDICARE: ABILITIES MIDWEST

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1568037158
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABILITIES MIDWEST

Provider Business Mailing Address
First Line	:	1218 STATE ST
Second Line	:
City	:	RIVER FALLS
State	:	WI
Zip	:	54022-3127
Country	:	US
Telephone Number	:	651-600-6848
Fax Number	:

Provider Business Practice Location Address
First Line	:	1218 STATE ST
Second Line	:
City	:	RIVER FALLS
State	:	WI
Zip	:	54022-3127
Country	:	US
Telephone Number	:	651-600-6848
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KATELYN HARTMAN
Credential	:
Telephone Number	:	651-600-6848

Provider Enumeration Date	:	05/25/2021
Last Update Date	:	05/25/2021

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Directions to “ABILITIES MIDWEST ” Practice Location

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