| NPI | 1619915741 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHASE L BEHRENDT Administrator 715-344-2164 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: WI 0917050001) |
| Enumeration Date | 2006-06-02 |
| Last Update Date | 2014-02-19 |