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Organization
COMMUNITY CARE OF CENTRAL WISCONSIN
Active
Organization
COMMUNITY CARE OF CENTRAL WISCONSIN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LUCY ELLEN RUNNELLS MPA (CHIEF FINANCIAL OFFICER)
(715) 204-1810
Entity
Organization
Contact information
Practice address
3349 CHURCH ST STE 1, STEVENS POINT, WI 54481-5314
(715) 345-5968
(715) 345-5725
Mailing address
3349 CHURCH ST STE 1, STEVENS POINT, WI 54481-5314
(715) 345-5968
(715) 345-5725
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
69005700
—
WI
Enumeration date
08/08/2008
Last updated
08/08/2008
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