NPIMap

Organization Active NPI

Premier Care of Wisconsin, LLC.

Doing business as CMS Fond Du Lac

  • Methadone Clinic
  • Fond Du Lac, WI
National Provider Identifier
1265143945
Registry record updated Feb 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Methadone ClinicTaxonomy code 261QM2800X
Legal business name
PREMIER CARE OF WISCONSIN, LLC.
Doing business as
CMS Fond Du Lac
Practice address
23 W Scott St
Fond Du Lac, WI 54935-2342
Phone
(920) 926-0101
Fax
(920) 926-0060
NPI assigned
Dec 13, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 10, 2024

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

Authorized official

Name
Cindy Gaither
Title
Vice President Revenue Cycle Manage
Phone
(602) 248-8886

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YA0400X
Community/Behavioral Health Agency 251S00000X
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X
Methadone Clinic 261QM2800X Primary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X

Addresses

Primary practice location

23 W Scott St
Fond Du Lac, WI 54935-2342

Mailing address

8444 N 90TH St Ste 100
Scottsdale, AZ 85258-4437
Phone (160) 248-8886

Other names 1

  • CMS FOND DU LAC Doing business as

National Provider Directory

National Provider Directory
Tax ID family
CMS Fond Du Lac9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

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": "1670889600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1707523200000",
    "number": "1265143945",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8444 N 90TH ST STE 100",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852584437",
            "telephone_number": "160-248-8886"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23 W SCOTT ST",
            "city": "FOND DU LAC",
            "state": "WI",
            "postal_code": "549352342",
            "telephone_number": "920-926-0101",
            "fax_number": "920-926-0060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER CARE OF WISCONSIN, LLC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-12-13",
        "last_updated": "2024-02-10",
        "certification_date": "2024-02-10",
        "status": "A",
        "authorized_official_last_name": "GAITHER",
        "authorized_official_first_name": "CINDY",
        "authorized_official_title_or_position": "VICE PRESIDENT REVENUE CYCLE MANAGE",
        "authorized_official_telephone_number": "602-248-8886"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM2800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Methadone",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CMS FOND DU LAC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "CMS FOND DU LAC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fond Du Lac, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2024; 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.