Provider Demographics
NPI:1558718874
Name:FAMILY HEALTH CENTER OF MARSHFIELD INC
Entity Type:Organization
Organization Name:FAMILY HEALTH CENTER OF MARSHFIELD INC
Other - Org Name:FAMILY HEALTH CENTER/ALCOHOL & DRUG RECOVERY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF FAMILY HEALTH CENTER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:R
Authorized Official - Last Name:NYCZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-387-9137
Mailing Address - Street 1:1000 N OAK AVE
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:54449-5703
Mailing Address - Country:US
Mailing Address - Phone:715-389-0780
Mailing Address - Fax:
Practice Address - Street 1:9792 HWY 70
Practice Address - Street 2:
Practice Address - City:MINOCQUA
Practice Address - State:WI
Practice Address - Zip Code:54548-8747
Practice Address - Country:US
Practice Address - Phone:715-358-1208
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAMILY HEALTH CENTER OF MARSHFIELD INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-05-17
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty