1558798686 NPI number — FRIENDS OF WOMEN IN RECOVERY, INC.

Table of content: (NPI 1558798686)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558798686 NPI number — FRIENDS OF WOMEN IN RECOVERY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FRIENDS OF WOMEN IN RECOVERY, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
BEACON HOUSE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1558798686
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/12/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1524
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FOND DU LAC
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54936-1524
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
920-923-3999
Provider Business Mailing Address Fax Number:
920-923-3240

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
166 S PARK AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FOND DU LAC
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54935-4441
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
920-923-3999
Provider Business Practice Location Address Fax Number:
920-923-3240
Provider Enumeration Date:
10/03/2013

Additional Information

Authorized Official

Authorized Official Last Name:
SCHMIT
Authorized Official First Name:
TRACY
Authorized Official Middle Name:
Authorized Official Title or Position:
OPERATIONS DIRECTOR
Authorized Official Telephone Number:
920-923-3999

Provider Taxonomy Codes

  • Taxonomy code: 324500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com