Provider Demographics
NPI:1518367226
Name:NORTHREACH HEALTHCARE LLC
Entity Type:Organization
Organization Name:NORTHREACH HEALTHCARE LLC
Other - Org Name:BELLIN HEALTH NORTHREACH URGENT CARE
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:SUITE 4
Practice Address - City:MARINETTE
Practice Address - State:WI
Practice Address - Zip Code:54143-4292
Practice Address - Country:US
Practice Address - Phone:715-732-8610
Practice Address - Fax:715-732-8650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-29
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI000040160Medicare Oscar/Certification