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Organization
HEADWATERS, INC.
Active
Organization
HEADWATERS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY HARDTKE (DIRECTOR)
(715) 369-1337
Entity
Organization
Contact information
Practice address
1441 E TIMBER DR, RHINELANDER, WI 54501-2887
(715) 369-1337
(715) 369-1793
Mailing address
PO BOX 618, RHINELANDER, WI 54501-0618
(715) 369-1337
(715) 369-1793
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
252Y00000X
Early Intervention Provider Agency
—
—
261QD1600X
Developmental Disabilities Clinic/Center
—
—
347B00000X
Bus
—
—
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
Primary
—
—
Other
Enumeration date
11/29/2011
Last updated
11/29/2011
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