NPIMap

Organization Active NPI

Family Services of Northeast Wisconsin, Inc.

  • Psychiatric Residential Treatment Facility
  • Green Bay, WI
National Provider Identifier
1225155245
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric Residential Treatment FacilityTaxonomy code 323P00000X
License
1005260 Issued in WI
Legal business name
FAMILY SERVICES OF NORTHEAST WISCONSIN, INC.
Practice address
3430 Spirit Way
Green Bay, WI 54304-5687
Phone
(920) 330-0339
Fax
(920) 330-9060
NPI assigned
Mar 23, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Thomas Martin
Title
President-Ceo
Phone
(920) 436-6800

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Residential Treatment Facility 323P00000X 1005260 WI Primary

Addresses

Primary practice location

3430 Spirit Way
Green Bay, WI 54304-5687

Mailing address

300 Crooks St
Green Bay, WI 54301-4527
Phone (920) 436-6800

Other identifiers 1

IdentifierTypeStateIssuer
43016200MedicaidWI

Other names 1

  • Family Services - Residential Treatment Other name

National Provider Directory

National Provider Directory
Tax ID family
Family SVCS of NE Wisco10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

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

Locations

3430 Spirit Way
Green Bay, WI 54304
Phone (920) 330-0339

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1174608000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1225155245",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 CROOKS ST",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543014527",
            "telephone_number": "920-436-6800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3430 SPIRIT WAY",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543045687",
            "telephone_number": "920-330-0339",
            "fax_number": "920-330-9060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY SERVICES OF NORTHEAST WISCONSIN, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-23",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MARTIN",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_title_or_position": "PRESIDENT-CEO",
        "authorized_official_telephone_number": "920-436-6800"
    },
    "taxonomies": [
        {
            "code": "323P00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Residential Treatment Facility",
            "state": "WI",
            "license": "1005260",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "43016200",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Family Services - Residential Treatment",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Green Bay, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.