Provider Demographics
NPI:1245487065
Name:NORTHWOODS INC OF WISCONSIN
Entity type:Organization
Organization Name:NORTHWOODS INC OF WISCONSIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:H
Authorized Official - Last Name:AERTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-742-7114
Mailing Address - Street 1:N6510 US HIGHWAY 51
Mailing Address - Street 2:PO BOX 357
Mailing Address - City:PORTAGE
Mailing Address - State:WI
Mailing Address - Zip Code:53901-9603
Mailing Address - Country:US
Mailing Address - Phone:608-742-7114
Mailing Address - Fax:608-742-0636
Practice Address - Street 1:N6510 US HIGHWAY 51
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:WI
Practice Address - Zip Code:53901-9603
Practice Address - Country:US
Practice Address - Phone:608-742-7114
Practice Address - Fax:608-742-0636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-22
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No251B00000XAgenciesCase Management
No251V00000XAgenciesVoluntary or Charitable