Organization Name: | HUMAN SERVICES BOARD SERVING NORTH CENTRAL HEATLH CARE |
NPI Number: | 1285749341 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | GARY BEZUCHA (CEO) |
Mailing Address: | 310 W Wisconsin Ave Tomahawk |
State: | WI US |
Postal Code: | 544871132 |
Phone Number: | 7154535381 |
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: | 1681 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WI |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Multi-Specialty |
Taxonomy Definition: |