Provider Demographics
NPI:1891029112
Name:NORTH CENTRAL HEALTH CARE MOUNTVIEW
Entity Type:Organization
Organization Name:NORTH CENTRAL HEALTH CARE MOUNTVIEW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OTR
Authorized Official - Prefix:MISS
Authorized Official - First Name:STACY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHUBERT
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:715-570-1717
Mailing Address - Street 1:1352 N 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:WEST BEND
Mailing Address - State:WI
Mailing Address - Zip Code:53090-1814
Mailing Address - Country:US
Mailing Address - Phone:262-391-8666
Mailing Address - Fax:
Practice Address - Street 1:2400 MARSHALL ST
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54403-6738
Practice Address - Country:US
Practice Address - Phone:715-848-4300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-21
Last Update Date:2009-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4721027314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility