# OCONOMOWOC DEVELOPMENTAL TRAINING CENTER OF WISCONSIN LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** Oconomowoc Developmental Training Center ODTC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1720117583
- **Authorized official:** MS. M DEBORAH FRISK MSW (VICE PRESIDENT)
- **Authorized official phone:** (262) 569-5515

## Contact information

- **Practice address:** 36100 GENESEE LAKE RD, OCONOMOWOC, WI 53066
- **Practice address phone:** (262) 569-5515
- **Practice address fax:** (262) 569-9962
- **Mailing address:** PO BOX 278, DOUSMAN, WI 53118
- **Mailing address phone:** (262) 569-5515
- **Mailing address fax:** (262) 569-9962

## Taxonomy

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

## Other

- **Enumeration date:** 03/05/2007
- **Last updated:** 08/22/2020