# STATE OF WISCONSIN

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Central Wisconsin Center for the Developmentally Disabled
- **Organization subpart:** No

## Provider details

- **NPI number:** 1386705655
- **Authorized official:** DR. WALTON O SCHALICK III MD,PHD (MEDICAL DIRECTOR)
- **Authorized official phone:** (609) 301-9231

## Contact information

- **Practice address:** 317 KNUTSON DR, MADISON, WI 53704-1133
- **Practice address phone:** (608) 301-9200
- **Practice address fax:** (608) 301-1811
- **Mailing address:** 317 KNUTSON DR, MADISON, WI 53704-1133
- **Mailing address phone:** (608) 301-9200
- **Mailing address fax:** (608) 301-1811

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | 2780 | WI | Yes |

## Other

- **Enumeration date:** 12/12/2006
- **Last updated:** 12/10/2024