Organization
COMMUNITY CARE OF PORTAGE COUNTY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES CANALES (DIRECTOR)
(715) 345-5800
Entity
Organization
Contact information
Practice address
817 WHITING AVE, STEVENS POINT, WI 54481-5246
(715) 345-5968
(715) 345-5725
Mailing address
817 WHITING AVE, STEVENS POINT, WI 54481-5246
(715) 345-5968
(715) 345-5725
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
69005700
—
WI
Enumeration date
03/27/2007
Last updated
08/22/2020
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