Provider Demographics
NPI:1417095464
Name:NORTHLAND COMMUNITY SERVICES INC.
Entity Type:Organization
Organization Name:NORTHLAND COMMUNITY SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHARLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-296-3811
Mailing Address - Street 1:328 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53964-9039
Mailing Address - Country:US
Mailing Address - Phone:608-296-3811
Mailing Address - Fax:608-296-2480
Practice Address - Street 1:328 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:WI
Practice Address - Zip Code:53964-9039
Practice Address - Country:US
Practice Address - Phone:608-296-3811
Practice Address - Fax:608-296-2480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI241251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41527300Medicaid
WI527215Medicare ID - Type UnspecifiedLEGACY NUMBER