NPIMap

Organization Active NPI

Oconomowoc Devemopmental Training Center LL

  • Intellectual and/or Developmental Disabilities Residential Treatment Facility
  • Dousman, WI
National Provider Identifier
1013240696
Registry record updated Sep 14, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X
Legal business name
OCONOMOWOC DEVEMOPMENTAL TRAINING CENTER LL
Practice address
201-203 Cory Ave.
Dousman, WI 53118
Phone
(262) 569-5515
Fax
(262) 569-9962
NPI assigned
Sep 14, 2009
Organization subpart
Yes
Parent organization
OCONOMOWOC DEVEMOPMENTAL TRAINING CENTER LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 14, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. M. Deborah Frisk, MSW
Title
Vice President
Phone
(262) 569-5515

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual and/or Developmental Disabilities Residential Treatment Facility 320600000X WI Primary

Addresses

Primary practice location

201-203 Cory Ave.
Dousman, WI 53118

Mailing address

PO Box 278
Dousman, WI 53118
Phone (262) 569-5515

Other names 1

  • Cory House Group Home Other name

National Provider Directory

National Provider Directory
Tax ID family
Oconomowoc Developmental Training Center of Wisconsin LLC5 organizations share this tax ID, including this one
Part of
Oconomowoc Developmental Training Center of Wisconsin LLC

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1252886400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1252886400000",
    "number": "1013240696",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 278",
            "city": "DOUSMAN",
            "state": "WI",
            "postal_code": "53118",
            "telephone_number": "262-569-5515",
            "fax_number": "262-569-9962"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201-203 CORY AVE.",
            "city": "DOUSMAN",
            "state": "WI",
            "postal_code": "53118",
            "telephone_number": "262-569-5515",
            "fax_number": "262-569-9962"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OCONOMOWOC DEVEMOPMENTAL TRAINING CENTER LL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "OCONOMOWOC DEVEMOPMENTAL TRAINING CENTER LLC",
        "enumeration_date": "2009-09-14",
        "last_updated": "2009-09-14",
        "status": "A",
        "authorized_official_last_name": "FRISK",
        "authorized_official_first_name": "M.",
        "authorized_official_middle_name": "DEBORAH",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "262-569-5515",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "MSW"
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "WI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cory House Group Home",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Dousman, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.