| NPI | 1093768962 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSEPH D MALAS CFO 815-971-6738 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 282N00000X General Acute Care Hospital (Licence: WI 310800) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: WI 310-800) |
| 261Q00000X Clinic/Center (Licence: WI 310800) | |
| 261QM0855X Clinic/Center Adolescent and Children Mental Health (Licence: WI 310800) | |
| 261QP2000X Clinic/Center Physical Therapy (Licence: WI 310-800) | |
| 291U00000X Clinical Medical Laboratory | |
| 332B00000X Durable Medical Equipment & Medical Supplies (Licence: WI 310800) | |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2025-06-10 |