Provider Demographics
NPI:1003953019
Name:NORTHREACH HEALTHCARE LLC
Entity Type:Organization
Organization Name:NORTHREACH HEALTHCARE LLC
Other - Org Name:NORTHREACH LAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:K
Authorized Official - Last Name:STROOBANTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-445-7226
Mailing Address - Street 1:3120 RIVERSIDE AVE
Mailing Address - Street 2:GATE B BUILDING 1
Mailing Address - City:MARINETTE
Mailing Address - State:WI
Mailing Address - Zip Code:54143-6007
Mailing Address - Country:US
Mailing Address - Phone:715-732-2075
Mailing Address - Fax:715-732-2092
Practice Address - Street 1:3200 SHORE DR
Practice Address - Street 2:UPPER LEVEL
Practice Address - City:MARINETTE
Practice Address - State:WI
Practice Address - Zip Code:54143-4202
Practice Address - Country:US
Practice Address - Phone:715-732-8645
Practice Address - Fax:715-732-8652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
52D0394498291U00000X
WI52D2088280291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
WICLIA NUMBEROther52D2088280
WI52D0394498OtherCLIA NUMBER