State of Wisconsin
NPI #1235225616 in Chippewa Falls, Wisconsin
Provider Information
- NPI Number
- 1235225616
- Entity Type
- Organization
- Organization Name
- State of Wisconsin
- Primary Specialty
- Intermediate Care Facility, Intellectual Disabilities
- Enumeration Date
- Oct 5, 2006
- Last Updated
- Apr 30, 2025
Practice Location
- Address
- 2820 EAST PARK AVENUE
- City
- Chippewa Falls
- State
- Wisconsin
- ZIP Code
- 54729-0340
- Phone
- (715) 723-7957
Authorized Official
- Name
- CRAIG KOEHLER
- Title
- DIRECTOR
- Phone
- (715) 723-5542
Specialties & Taxonomy Codes
| Specialty |
|---|
| Intermediate Care Facility, Intellectual Disabilities |
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