Provider Demographics
NPI:1508641291
Name:CORR HEALTH WI, SC
Entity Type:Organization
Organization Name:CORR HEALTH WI, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PAULL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-830-8707
Mailing Address - Street 1:961 BROADWAY STE 103
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-1733
Mailing Address - Country:US
Mailing Address - Phone:646-830-8707
Mailing Address - Fax:
Practice Address - Street 1:250 E WISCONSIN AVE FL 18
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-4232
Practice Address - Country:US
Practice Address - Phone:414-347-7800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-30
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care