Organization · Type 2 NPI

State of Wisconsin

Intellectual Disabilities Intermediate Care Facility · Chippewa Falls, WI

NPI number 1235225616 Active

Practice location

2820 East Park Avenue
Chippewa Falls, WI 54729-0340

Specialties and licenses

Taxonomy	Code	License
Intellectual Disabilities Intermediate Care Facility Primary	315P00000X	2753 (WI)

Intellectual Disabilities Intermediate Care Facility: An intermediate care facility providing services for individuals with intellectual disabilities.

NPI record

NPI: 1235225616
Entity type: Organization (Type 2)
Issued: Oct 5, 2006
Last updated: Apr 30, 2025
Status: Active

Other names

<unavail>
Northern Wisconsin Center Excel · doing business as
Northern Wisconsin Center Excel · doing business as

Authorized official

Craig Koehler
Director
(715) 723-5542

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This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1235225616

State of Wisconsin's National Provider Identifier is 1235225616, issued on Oct 5, 2006. The primary taxonomy on file is Intellectual Disabilities Intermediate Care Facility (315P00000X), and the practice location is in Chippewa Falls, WI. The record was last updated on Apr 30, 2025.