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MYSTIC CREEK LLC NPI 1356700025


NPI Information

NPI: 1356700025
Provider Name: MYSTIC CREEK, LLC
Classification: Residential Treatment Facility, Intellectual and/or Developmental Disabilities - 320600000X
Entity Type: Organization
Address:
12489 STATE HIGHWAY 56
VIOLA, WI
ZIP 54664
Phone: (608) 538-3781
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MYSTIC CREEK, LLC is a residential treatment facility, intellectual and/or developmental disabilities in Viola, WI. The provider is a residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental and intellectual disabilities and are not able to live independently. MYSTIC CREEK, LLC NPI is 1356700025. The provider is registered as an organization entity type.

The provider's business location address is:

12489 STATE HIGHWAY 56
VIOLA, WI
ZIP 54664-914
Phone: (608) 538-3781
Fax: (608) 538-3782

The provider's authorized official is Diane Cook .
The authorized official title is Owner and has the following contact phone number (608) 538-3781.

The enumeration date for this NPI number is 2/23/2016 and was last updated on 2/23/2016.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1320600000XResidential Treatment Facility, Intellectual and/or Developmental DisabilitiesYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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