Provider Demographics
NPI:1740561521
Name:THE CENTER FOR HUMAN RESTORATION, INC
Entity Type:Organization
Organization Name:THE CENTER FOR HUMAN RESTORATION, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:CONNOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-478-5202
Mailing Address - Street 1:PO BOX 39
Mailing Address - Street 2:
Mailing Address - City:CRANDON
Mailing Address - State:WI
Mailing Address - Zip Code:54520-0039
Mailing Address - Country:US
Mailing Address - Phone:715-478-5202
Mailing Address - Fax:
Practice Address - Street 1:505 W GLEN ST STE 1
Practice Address - Street 2:
Practice Address - City:CRANDON
Practice Address - State:WI
Practice Address - Zip Code:54520-1356
Practice Address - Country:US
Practice Address - Phone:715-478-5202
Practice Address - Fax:715-478-5205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-07
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4632-012261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center