NORTHWEST PASSAGE LTD (NPI# 1235266065) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1235266065 |
| Entity Type | Organization |
| Organization Name | NORTHWEST PASSAGE LTD |
| Practice Address |
203 United Way Drive Frederic WI 54837-8938 |
| Practice Telephone | 7153274402 |
| Practice Fax Number | 7153274470 |
| Mailing Telephone | 7153274322 |
| Mailing Fax Number | 7153278509 |
| Enumeration Date | 2007-02-28 |
| Last Update Date | 2012-03-27 |
| Authorized Official Name | JACKIE J MAURER (BUSINESS OFFICE SUPERVISOR) |
| Authorized Official Telephone | 7153274322 |
| Is Organization Subpart | Y |
| Parent Organization Name | NORTHWEST PASSAGE |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 322D00000X | Residential Treatment Facility, Emotionally Disturbed Children | 560014 | WI | Residential Treatment Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | HEALTH PARTNERS | NONE | 01 |
| MN | BCBS OF MN | 3181NO | 01 |
| WI | 43015400 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639294168 | Northwest Passage Ltd | Residential Treatment Facility, Emotionally Disturbed Children | 7818 Moline Road, Webster, WI 54893-8545 | 2007-03-21 |
| Street Address |
203 UNITED WAY DRIVE |
| City | FREDERIC |
| State | WI |
| Zip Code | 54837-8938 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366526956 | Northwest Pediatric Specialties, Inc. | Specialist | 203 United Way Drive, Frederic, WI 54837-8938 | 2006-10-24 |
| 1710022298 | Cynthia L Boykin | Psychologist | 203 United Way Drive, Frederic, WI 54837-8938 | 2007-02-21 |
| 1225173644 | Tara L Mitchell | Counselor | 203 United Way Drive, Frederic, WI 54837-8938 | 2007-02-21 |
| 1619002839 | Timothy D Newlin | Counselor | 203 United Way Drive, Frederic, WI 54837-8938 | 2007-02-21 |
| 1104990530 | Northwest Counseling & Guidance Clinic | Clinic/Center | 203 United Way Drive, Frederic, WI 54837-8938 | 2006-11-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548639636 | Austin Ross | Pharmacist | 201 Oak St West, Frederic, WI 54837 | 2015-09-18 |
| 1811256126 | St. Croix Regional Medical Center | Clinic/Center | 205 West Oak Street, Frederic, WI 54837 | 2012-05-07 |
| 1447497763 | Saint-mark Enterprises 1855 LLC | Durable Medical Equipment & Medical Supplies | 110 E Oak St, Frederic, WI 54837 | 2009-01-08 |
| 1639263221 | Pharmacy Operations Inc | Pharmacy | 110 E Oak Street, Frederic, WI 54837 | 2006-10-03 |
| 1457338139 | Joseph L Marek | Chiropractor | 101 United Way, Frederic, WI 54837 | 2005-12-23 |
| 1669572590 | Steven Richard Tesch | Dentist | 106 S Wisconsin Ave, Frederic, WI 54837-0250 | 2006-09-22 |
| 1306946223 | Bradley Scott Harlander | Dentist | 106 S Wisconsin Ave, Frederic, WI 54837-0250 | 2006-09-22 |
| 1689004426 | Kristina M Thompson | Social Worker | 107 Hope Road West, Frederic, WI 54837-0383 | 2013-11-14 |
| 1588158679 | Hope Road Wellness Center, LLC | Social Worker | 107 Hope Road West, Frederic, WI 54837-0383 | 2018-06-21 |
| 1043499734 | School District of Frederic | Local Education Agency (LEA) | 1437 Clam Falls Dr, Frederic, WI 54837-4547 | 2007-10-30 |
| Find all providers in zip 54837 | ||||
| Taxonomy Code | 322D00000X |
| Grouping | Residential Treatment Facilities |
| Classification | Residential Treatment Facility, Emotionally Disturbed Children |
| A provider facility or distinct part of the organization which renders an interdisciplinary program of mental health treatment to individuals under 21 years of age who have persistent dysfunction in major life areas. The dysfunction is of an extent and pervasiveness that requires a protected and highly structured therapeutic environment. These organizations, or distinct part of organizations, exclude those that provide acute psychiatric care, partial hospitalization, group living, therapeutic schooling, primary diagnosis substance abuse disorder treatment, or primary diagnosis mental retardation or developmental disability treatment. |
| Notes: Source: U.S. Department of Defense Regulation 6010.8-R, Chapter 6. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134764103 | Anders Developmental & Transition Home LLC | Residential Treatment Facility, Emotionally Disturbed Children | 3359 N 25th St, Milwaukee, WI 53206-1237 | 2019-11-13 |
| 1689145500 | Oconomowoc Developmental Training Center of Wisconsin LLC | Residential Treatment Facility, Emotionally Disturbed Children | 36100 Genesee Lake School, Oconomowoc, WI 53066 | 2018-12-17 |
| 1033417670 | Allendale Association | Residential Treatment Facility, Emotionally Disturbed Children | 12603 224th Ave, Benet Lake, WI 53102-1000 | 2011-03-07 |
| 1366601718 | Mercy Assisted Care Inc | Residential Treatment Facility, Emotionally Disturbed Children | 20 E Court St, Janesville, WI 53545-3976 | 2008-06-02 |
| 1346415445 | Carmelite Home, Inc | Residential Treatment Facility, Emotionally Disturbed Children | 1214 Kavanaugh Pl, Wauwatosa, WI 53213-2506 | 2008-04-29 |
| 1861666943 | Tomorrow's Children, Inc. | Residential Treatment Facility, Emotionally Disturbed Children | N3066 Tomorrow's Lane, Waupaca, WI 54981-0192 | 2008-04-18 |
| 1629261086 | Willowglen Academy - Howard | Residential Treatment Facility, Emotionally Disturbed Children | 3959 S 51st St, Milwaukee, WI 53220-2653 | 2007-08-20 |
| 1093908451 | Willowglen Academy - Wilson | Residential Treatment Facility, Emotionally Disturbed Children | 3603 S Business Dr, Sheboygan, WI 53081-7096 | 2007-08-20 |
| 1669670477 | Willowglen Academy-wisconsin, Inc. | Residential Treatment Facility, Emotionally Disturbed Children | 1111 Reed St, Plymouth, WI 53073-2506 | 2007-07-03 |
| 1457559262 | Willowglen Hein Foster Care Group Home | Residential Treatment Facility, Emotionally Disturbed Children | 207 Hein Ave, Plymouth, WI 53073-2526 | 2007-07-03 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.