Provider Demographics
NPI:1932714292
Name:HUMAN SERVICES BOARD SERVING NORTH CENTRAL HEALTH CARE FACILITY
Entity Type:Organization
Organization Name:HUMAN SERVICES BOARD SERVING NORTH CENTRAL HEALTH CARE FACILITY
Other - Org Name:NORTH CENTRAL HEALTH CARE YOUTH BEHAVIORAL HEALTH HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:D
Authorized Official - Last Name:OLSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-848-4600
Mailing Address - Street 1:2400 MARSHALL ST STE A
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54403-6738
Mailing Address - Country:US
Mailing Address - Phone:715-848-4600
Mailing Address - Fax:
Practice Address - Street 1:2380 MARSHALL ST.
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54403
Practice Address - Country:US
Practice Address - Phone:715-848-4600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HUMAN SERVICES BOARD SERVING NORTH CENTRAL HEALTH CARE FACILITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-09-14
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
No284300000XHospitalsSpecial Hospital