Provider Demographics
NPI:1699176479
Name:HOLY FAMILY MEMORIAL, INC
Entity Type:Organization
Organization Name:HOLY FAMILY MEMORIAL, INC
Other - Org Name:HOLY FAMILY MEMORIAL WORK HEALTH OPTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:R
Authorized Official - Last Name:HUETTL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-320-3486
Mailing Address - Street 1:2300 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-3712
Mailing Address - Country:US
Mailing Address - Phone:920-320-2011
Mailing Address - Fax:920-320-3500
Practice Address - Street 1:1650 S 41ST ST
Practice Address - Street 2:
Practice Address - City:MANITOWOC
Practice Address - State:WI
Practice Address - Zip Code:54220-7316
Practice Address - Country:US
Practice Address - Phone:920-320-4660
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOLY FAMILY MEMORIAL, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-09-11
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care