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Organization
PREMIER CARE OF WISCONSIN, LLC.
Active
Organization
PREMIER CARE OF WISCONSIN, LLC.
Active
Other names
CMS FOND DU LAC
Organization subpart
No
Provider details
NPI number
Authorized official
CINDY GAITHER (VP REVENUE CYCLE MGMT)
(602) 248-8886
Entity
Organization
Contact information
Practice address
23 W SCOTT ST, FOND DU LAC, WI 54935-2342
(920) 926-0101
Mailing address
8444 N 90TH ST STE 100, SCOTTSDALE, AZ 85258-4437
(602) 248-8886
(480) 687-7361
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
251S00000X
Community/Behavioral Health Agency
3075
WI
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QM2800X
Methadone Clinic
Primary
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
—
Other
Enumeration date
06/09/2015
Last updated
02/10/2024
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