State of Wisconsin

Primary specialty

Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X

License

2753 Issued in WI

Legal business name

STATE OF WISCONSIN

Practice address

2820 East Park Avenue
Chippewa Falls, WI 54729-0340

Phone

(715) 723-7957

NPI assigned

Oct 5, 2006

Organization subpart

No

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

Authorized official

Name

Craig Koehler

Title

Director

Phone

(715) 723-5542

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Northern Wisconsin Center Excel Doing business as

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Other NPIs on the same Medicare enrollment 4

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• State of Wisconsin

  • Intellectual Disabilities Intermediate Care Facility
  • Union Grove, WI
  • NPI 1043326747

  O20050214000153

  Same enrollment
• State of Wisconsin

  • Intellectual and/or Developmental Disabilities Residential Treatment Facility
  • Madison, WI
  • NPI 1386705655

  O20050214000153

  Same enrollment
• State of Wisconsin

  • General Acute Care Hospital
  • Madison, WI
  • NPI 1437253648

  O20050214000153

  Same enrollment
• Winnebago Mental Health Institute

  • Psychiatric Hospital
  • Winnebago, WI
  • NPI 1164516506

  O20050214000153

  Same enrollment

Locations

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

{
    "created_epoch": "1160006400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1745971200000",
    "number": "1235225616",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2820 EAST PARK AVENUE",
            "city": "CHIPPEWA FALLS",
            "state": "WI",
            "postal_code": "547290340"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2820 EAST PARK AVENUE",
            "city": "CHIPPEWA FALLS",
            "state": "WI",
            "postal_code": "547290340",
            "telephone_number": "715-723-7957"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE OF WISCONSIN",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-05",
        "last_updated": "2025-04-30",
        "certification_date": "2021-10-19",
        "status": "A",
        "authorized_official_last_name": "KOEHLER",
        "authorized_official_first_name": "CRAIG",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "715-723-5542"
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "WI",
            "license": "2753",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "21050200",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Northern Wisconsin Center Excel",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Northern Wisconsin Center Excel",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• St. Joseph'S Hospital
• St. Joseph'S Hospital - Chippewa Falls
• St. Joseph'S Hospital of the Hospital Sisters of the 3Rd Order of St F
• St. Josephs Hospital
• St. Josephs Hospital of the Hospital Sisters of the Third Order of St
• State of Wisconsin
• Mark Charles Steinmetz, M.D.
• Steven W Steinmetz, MD
• Ann Stien
• Kelly Stillman

• All providers in Chippewa Falls, WI
• Intellectual Disabilities Intermediate Care Facility in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.