Organization
NORTHWEST PASSAGE - NORTHWEST PASSAGE II
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK ELLIOT (PROGRAM DIRECTOR)
(715) 327-4402
Entity
Organization
Contact information
Practice address
1661 HAMS RD, SPOONER, WI 54801-9138
(715) 635-7204
Mailing address
1661 HAMS RD, SPOONER, WI 54801-9138
(715) 635-7204
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
1004165
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3181NO
BCBS OF MN
MN
05
—
43015500
—
WI
Enumeration date
03/20/2007
Last updated
08/22/2020
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