# COMMUNITY CARE OF CENTRAL WISCONSIN

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1407002546
- **Authorized official:** LUCY ELLEN RUNNELLS MPA (CHIEF FINANCIAL OFFICER)
- **Authorized official phone:** (715) 204-1810

## Contact information

- **Practice address:** 3349 CHURCH ST STE 1, STEVENS POINT, WI 54481-5314
- **Practice address phone:** (715) 345-5968
- **Practice address fax:** (715) 345-5725
- **Mailing address:** 3349 CHURCH ST STE 1, STEVENS POINT, WI 54481-5314
- **Mailing address phone:** (715) 345-5968
- **Mailing address fax:** (715) 345-5725

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 302F00000X | Exclusive Provider Organization | — | NULL | Yes |

## Other

- **Enumeration date:** 08/08/2008
- **Last updated:** 08/08/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 69005700 | — | WI |