Organization
CENTER FOR INDEPENDENT LIVING FOR WESTERN WISCONSIN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TAMMY GRAGE (HR/FISCAL MANAGER)
(715) 233-1070
Entity
Organization
Contact information
Practice address
2920 SCHNEIDER AVE SE, MENOMONIE, WI 54751-2331
(715) 233-1070
(715) 233-1083
Mailing address
2920 SCHNEIDER AVE SE, MENOMONIE, WI 54751-2331
(715) 233-1070
(715) 233-1083
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
43105700
—
WI
Enumeration date
10/16/2008
Last updated
10/16/2008
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