Organization
STATE OF WISCONSIN
Active
Other names
Northern Wisconsin Center Excel
Organization subpart
No
Provider details
NPI number
Authorized official
CRAIG KOEHLER (DIRECTOR)
(715) 723-5542
Entity
Organization
Contact information
Practice address
2820 EAST PARK AVENUE, CHIPPEWA FALLS, WI 54729-0340
(715) 723-7957
Mailing address
2820 EAST PARK AVENUE, CHIPPEWA FALLS, WI 54729-0340
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
2753
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
21050200
—
WI
Enumeration date
10/05/2006
Last updated
04/30/2025
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