| Organization Name: | HUMAN SERVICES BOARD SERVING NORTH CENTRAL HEALTH CARE FACILITY |
| NPI Number: | 1225150170 |
| 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: | 7156276694 |
| Fax Number: | 7156276645 |
| NPI Enumeration Date: | 04/04/2007 |
| NPI Last Update Date: | 01/07/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QM1300X |
| License Number: | 2298 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WI |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Multi-Specialty |
| Taxonomy Definition: | |