STATE OF WISCONSIN (NPI# 1386705655) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1386705655 |
| Entity Type | Organization |
| Organization Name | STATE OF WISCONSIN |
| Other Organization Name | CENTRAL WISCONSIN CENTER FOR THE DEVELOPMENTALLY DISABLED |
| Practice Address |
317 Knutson Dr Madison WI 53704-1133 |
| Practice Telephone | 6083019200 |
| Practice Fax Number | 6083011811 |
| Mailing Telephone | 6083019200 |
| Mailing Fax Number | 6083011811 |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2008-02-08 |
| Authorized Official Name | DR. THEODORE J. BUNCK (DIRECTOR) |
| Authorized Official Telephone | 6083019200 |
| Authorized Official Credential | PH.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 320600000X | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 2780 | WI | Residential Treatment Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | 21050100 | 05 |
| Other Name | Type Code |
|---|---|
| Central Wisconsin Center for the Developmentally Disabled | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558615815 | State of Wisconsin | Skilled Nursing Facility | 2175 E Park Ave, Chippewa Falls, WI 54729-3511 | 2012-11-07 |
| 1225152861 | State of Wisconsin | Skilled Nursing Facility | 21425g Spring St, Union Grove, WI 53182-9707 | 2007-03-19 |
| 1235225616 | State of Wisconsin | Intermediate Care Facility, Mentally Retarded | 2820 East Park Avenue, Chippewa Falls, WI 54729-0340 | 2006-10-05 |
| 1366439986 | State of Wisconsin | Skilled Nursing Facility | N2665 County Road Qq, King, WI 54946 | 2005-09-29 |
| 1225362403 | State of Wisconsin | Durable Medical Equipment & Medical Supplies | 317 Knutson Dr, Madison, WI 53704-1133 | 2009-09-22 |
| 1336324946 | State of Wisconsin | Intermediate Care Facility, Mentally Retarded | 317 Knutson Dr, Madison, WI 53704-1133 | 2008-01-02 |
| 1588703078 | State of Wisconsin | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 317 Knutson Dr, Madison, WI 53704-1133 | 2007-02-05 |
| 1164516506 | State of Wisconsin | Psychiatric Hospital | 1300 South Drive, Winnebago, WI 54985-0009 | 2006-10-02 |
| 1437253648 | State of Wisconsin | General Acute Care Hospital | 301 Troy Dr, Madison, WI 53704-1521 | 2006-09-08 |
| 1043326747 | State of Wisconsin | Intermediate Care Facility, Mentally Retarded | 21425 Spring St, Union Grove, WI 53182-9707 | 2006-08-22 |
| Street Address |
317 KNUTSON DR |
| City | MADISON |
| State | WI |
| Zip Code | 53704-1133 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639174782 | Cari A Eggert | Physical Medicine & Rehabilitation | 317 Knutson Dr, Central Wisconsin Center, Madison, WI 53704-1133 | 2005-06-16 |
| 1588223424 | Alexandra Williams | Pharmacist | 317 Knutson Dr, Madison, WI 53704-1133 | 2019-06-12 |
| 1154835411 | Ashley Marie Alagna | Physical Therapist | 317 Knutson Dr, Madison, WI 53704-1133 | 2017-11-24 |
| 1891208534 | Sarah Wilkin | Occupational Therapist | 317 Knutson Dr, Madison, WI 53704-1133 | 2017-11-15 |
| 1396256038 | Abigail Marie Quamme | Physical Therapy Assistant | 317 Knutson Dr, Madison, WI 53704-1133 | 2017-10-21 |
| 1174043392 | Kris A Moeller | Occupational Therapist | 317 Knutson Dr, Madison, WI 53704-1133 | 2017-06-20 |
| 1952783706 | Theresa Murray | Physical Therapist | 317 Knutson Dr, Central Wisconsin Center, Pt/ot Rehab Department, Madison, WI 53704-1133 | 2015-06-28 |
| 1770964264 | Tegan Corrigan | Psychologist | 317 Knutson Dr, Madison, WI 53704-1133 | 2015-06-10 |
| 1689071599 | Clare Weege | Pharmacist | 317 Knutson Dr, Madison, WI 53704-1133 | 2014-11-21 |
| 1376974428 | Chelsea Cox | Physical Therapist | 317 Knutson Dr, Madison, WI 53704-1133 | 2013-11-27 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407369614 | Joseph Michael Oakley II | Chiropractor | 2801 International Ln Ste 102, Madison, WI 53704 | 2017-11-09 |
| 1972015048 | Suzanne Lee | Psychiatry & Neurology | 1835 Winnebago St. #402, Madison, WI 53704 | 2017-10-30 |
| 1831554021 | Gideon Kazah | Licensed Practical Nurse | 2488 Dahle Street, Madison, WI 53704 | 2015-12-15 |
| 1174952220 | Group Health Cooperative of South Central Wisconsin Madison College | Durable Medical Equipment & Medical Supplies | 1705 Hoffman Street, Madison, WI 53704 | 2013-11-08 |
| 1407190127 | Ashley Marie Snyder | Social Worker | 5203 Autumn Leaf Lane, Apt. 389, Madison, WI 53704 | 2012-11-19 |
| 1619230638 | Dawn Lynette Butts | Optometrist | 4208 E Washington Ave, Madison, WI 53704 | 2012-06-25 |
| 1679865992 | Sharon Kelley | Psychologist | 1213 N. Sherman Ave, Suite 334, Madison, WI 53704 | 2011-05-04 |
| 1578730412 | St. Charles Youth & Family Services | Community Based Residential Treatment Facility, Mental Illness | 310 Troy Dr, Cottage B, Madison, WI 53704 | 2008-05-09 |
| 1538346960 | Elizabeth Ann Reiser-loeber | Dentist | 1001 N. Sherman Ave, Madison, WI 53704 | 2008-01-28 |
| 1861683088 | Stephen Dale Flach | Internal Medicine | Covance, 3402 Kinsman Blvd, Madison, WI 53704 | 2007-08-05 |
| Find all providers in zip 53704 | ||||
| Taxonomy Code | 320600000X |
| Grouping | Residential Treatment Facilities |
| Classification | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities |
| A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental disabilities and/or mental retardation and are not able to live independently. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801256755 | Alpha & Omega Home/healthcare Services, Inc. | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 401 W Old Hickory Blvd, Madison, TN 37115-3609 | 2016-03-03 |
| 1154504983 | Madison Village Manor, Inc | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 731 N Lake St, Madison, OH 44057-3152 | 2007-12-15 |
| 1932328572 | Grand Manner, Inc | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 1954 Hubbard Rd, Madison, OH 44057-2154 | 2007-04-24 |
| 1356484315 | Living Opportunities Inc. | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 3142 County Line Rd, Madison, OH 44057-9705 | 2007-02-15 |
| 1972786705 | Madison Village Manor | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 148 E Main St, Madison, OH 44057-3226 | 2007-12-15 |
| 1588703078 | State of Wisconsin | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 317 Knutson Dr, Madison, WI 53704-1133 | 2007-02-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093252140 | Apria Residential Inc. | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 2833 S 12th St, Sheboygan, WI 53081-6703 | 2017-01-27 |
| 1316482920 | Cheryl Mcmahon | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 2483 28th St, Rice Lake, WI 54868-9098 | 2017-01-05 |
| 1093174765 | Diane Cook | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 12489 State Highway 56, Viola, WI 54664-8914 | 2016-02-23 |
| 1467810788 | Stonebrick Residential Living Facility LLC | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 4703 W Villard Ave, Milwaukee, WI 53218-4459 | 2016-02-01 |
| 1932574670 | Gayle Millis | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 3260 E Carollton Dr, Oak Creek, WI 53154-4165 | 2015-12-07 |
| 1942605670 | Methu Adult Family Care Home II | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 2824 N 59th St, Milwaukee, WI 53210-1504 | 2014-10-23 |
| 1720498736 | Kaiser Adult Family Care, LLC | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | W782 Leroy St, Edgar, WI 54426-9627 | 2014-04-29 |
| 1851721344 | Evergreen Pines Inc | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 343 E Cumberland St, Berlin, WI 54923-1206 | 2013-11-19 |
| 1679913487 | Berlin Pines, Inc | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 642 Broadway, Berlin, WI 54923-1302 | 2013-06-26 |
| 1245502053 | Gloria Aweke | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 1111 Gas Light Dr, Sun Prairie, WI 53590-3459 | 2012-02-08 |
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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.