Organization
VISTA CARE WISCONSIN INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TIMOTHY A. FREY (PRESIDENT)
(920) 457-0826
Entity
Organization
Contact information
Practice address
708 ERIE AVE STE 201, SHEBOYGAN, WI 53081-4060
(920) 457-0826
(920) 457-2207
Mailing address
708 ERIE AVE STE 201, SHEBOYGAN, WI 53081-4060
(920) 457-0826
(920) 457-2207
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
—
—
253Z00000X
In Home Supportive Care Agency
Primary
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
11183
WI
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
9340
WI
Other
Enumeration date
10/30/2007
Last updated
06/18/2025
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