Provider Demographics
NPI:1205262417
Name:HUMAN RESOURCE ASSISTANCE CENTER LLC
Entity type:Organization
Organization Name:HUMAN RESOURCE ASSISTANCE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:JEFFERY
Authorized Official - Last Name:DORN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-722-0313
Mailing Address - Street 1:1478 KENWOOD DR
Mailing Address - Street 2:SUITE 1D
Mailing Address - City:MENASHA
Mailing Address - State:WI
Mailing Address - Zip Code:54952-1161
Mailing Address - Country:US
Mailing Address - Phone:920-722-0311
Mailing Address - Fax:920-722-0313
Practice Address - Street 1:1478 KENWOOD DR
Practice Address - Street 2:SUITE 1D
Practice Address - City:MENASHA
Practice Address - State:WI
Practice Address - Zip Code:54952-1161
Practice Address - Country:US
Practice Address - Phone:920-722-0311
Practice Address - Fax:920-722-0313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-19
Last Update Date:2013-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility