1679684609 NPI number — CENTER FOR HUMAN DEVELOPMENT, INC.

Table of content: (NPI 1679684609)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679684609 NPI number — CENTER FOR HUMAN DEVELOPMENT, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTER FOR HUMAN DEVELOPMENT, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CENTER FOR HUMAN DEVELOPMENT
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1679684609
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/02/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
631 FOREST ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WAUSAU
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54403-5524
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
715-842-0944
Provider Business Mailing Address Fax Number:
715-845-6477

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
631 FOREST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAUSAU
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54403-5524
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-842-0944
Provider Business Practice Location Address Fax Number:
715-845-6477
Provider Enumeration Date:
08/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WEBSTER
Authorized Official First Name:
EDMUND
Authorized Official Middle Name:
LEE
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
715-842-0944

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  1153 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 42135100 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 62743 . This is a "MULTIPLAN/WPPN" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: DA2153 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 305912 . This is a "MHN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1008111 . This is a "CIGNA BEHAVIORAL HEALTH" identifier . This identifiers is of the category "OTHER".




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