Organization
NORTHWEST PASSAGE LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACKIE J MAURER (BUSINESS OFFICE SUPERVISOR)
(715) 327-4322
Entity
Organization
Contact information
Practice address
7818 MOLINE ROAD, WEBSTER, WI 54893-8545
(715) 866-8301
(715) 866-8374
Mailing address
203 UNITED WAY DRIVE, FREDERIC, WI 54837-8938
(715) 327-4322
(715) 327-8509
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
560014
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3181NO
BCBS OF MN
MN
05
—
43015300
—
WI
Enumeration date
03/21/2007
Last updated
03/27/2012
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