| Organization Name: | HUMAN SERVICES BOARD SERVING NORTH CENTRAL HEATLH CARE |
| NPI Number: | 1134234206 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | GARY BEZUCHA (CEO) |
| Mailing Address: | 1225 Langlade Rd Antigo |
| State: | WI US |
| Postal Code: | 544092762 |
| Phone Number: | 7156232394 |
| Fax Number: | |
| NPI Enumeration Date: | 08/20/2006 |
| NPI Last Update Date: | 06/27/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QM1300X |
| License Number: | 1676 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WI |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Multi-Specialty |
| Taxonomy Definition: | |