Provider Demographics
NPI:1326437294
Name:MJCARE
Entity Type:Organization
Organization Name:MJCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REHAB DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-445-2412
Mailing Address - Street 1:325 E. IOLA ST.
Mailing Address - Street 2:
Mailing Address - City:IOLA
Mailing Address - State:WI
Mailing Address - Zip Code:54945
Mailing Address - Country:US
Mailing Address - Phone:715-445-2412
Mailing Address - Fax:
Practice Address - Street 1:325 E. IOLA ST.
Practice Address - Street 2:
Practice Address - City:IOLA
Practice Address - State:WI
Practice Address - Zip Code:54945
Practice Address - Country:US
Practice Address - Phone:715-445-2412
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-15
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2194-19282NR1301X, 320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities
No282NR1301XHospitalsGeneral Acute Care HospitalRural