Provider Demographics
NPI:1851589634
Name:TRAVERSE CARE CENTER - WHEATON COMMUNITY HOSPITAL JPA
Entity Type:Organization
Organization Name:TRAVERSE CARE CENTER - WHEATON COMMUNITY HOSPITAL JPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH INFORMATION MANAGEMENT
Authorized Official - Prefix:
Authorized Official - First Name:DEB
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:RHIT
Authorized Official - Phone:320-563-8226
Mailing Address - Street 1:403 12TH ST N
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:MN
Mailing Address - Zip Code:56296-1070
Mailing Address - Country:US
Mailing Address - Phone:320-563-0078
Mailing Address - Fax:320-563-8746
Practice Address - Street 1:403 12TH ST N
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:MN
Practice Address - Zip Code:56296-1070
Practice Address - Country:US
Practice Address - Phone:320-563-0078
Practice Address - Fax:320-563-8746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-05
Last Update Date:2007-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN337816251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health