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Organization

PREMIER CARE OF WISCONSIN, LLC.

Active
Other names
CMS FOND DU LAC
Organization subpart
No

Provider details

NPI number
Authorized official
CINDY GAITHER (VICE PRESIDENT REVENUE CYCLE MANAGE)
(602) 248-8886
Entity
Organization

Contact information

Practice address
23 W SCOTT ST, FOND DU LAC, WI 54935-2342
(920) 926-0101
(920) 926-0060
Mailing address
8444 N 90TH ST STE 100, SCOTTSDALE, AZ 85258-4437
(160) 248-8886

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
251S00000X
Community/Behavioral Health Agency
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
261QM2800X
Methadone Clinic
Primary
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center

Other

Enumeration date
12/13/2022
Last updated
02/10/2024
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