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PRADER WILLI HOMES OF OCONOMOWOC LLC NPI 1396891875


NPI Information

NPI: 1396891875
Provider Name: PRADER WILLI HOMES OF OCONOMOWOC LLC

Doing Business As: PRADER WILLI HOMES OF OCONOMOWOC

Classification: Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities - 320900000X
Entity Type: Organization

CLIA Number: 52D2093179

Address:
1746 EXECUTIVE DRIVE
OCONOMOWOC, WI
ZIP 53066
Phone: (262) 569-5515
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PRADER WILLI HOMES OF OCONOMOWOC LLC is a community based residential treatment facility, intellectual and/or developmental disabilities in Oconomowoc, WI. The provider is a home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities. PRADER WILLI HOMES OF OCONOMOWOC LLC NPI is 1396891875. The provider is registered as an organization entity type.
The provider Is Doing Business As Prader Willi Homes Of Oconomowoc.

The provider's business location address is:

1746 EXECUTIVE DRIVE
OCONOMOWOC, WI
ZIP 53066
Phone: (262) 569-5515

The provider's authorized official is M Deborah Frisk .
The authorized official title is Vice President and has the following contact phone number (262) 569-5515.

The CLIA number assigned to this NPI record is 52D2093179 - assisted living facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 1/26/2007 and was last updated on 8/22/2020.


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
1320900000XCommunity Based Residential 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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