NPIMap

Organization Active NPI

Northwest Passage - Northwest Passage II

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Spooner, WI
National Provider Identifier
1285759035
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X
License
1004165 Issued in WI
Legal business name
NORTHWEST PASSAGE - NORTHWEST PASSAGE II
Practice address
1661 Hams Rd
Spooner, WI 54801-9138
Phone
(715) 635-7204
NPI assigned
Mar 20, 2007
Last updated
Aug 22, 2020By the provider in NPPES
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
Mark Elliot
Title
Program Director
Phone
(715) 327-4402

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X 1004165 WI Primary

Addresses

Primary practice location

1661 Hams Rd
Spooner, WI 54801-9138

Mailing address

1661 Hams Rd
Spooner, WI 54801-9138
Phone (715) 635-7204

Other identifiers 2

IdentifierTypeStateIssuer
3181NOOtherMNBCBS OF MN
43015500MedicaidWI

National Provider Directory

National Provider Directory
Tax ID family
Northwest Passage - Northwest Passage II3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1174348800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1285759035",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1661 HAMS RD",
            "city": "SPOONER",
            "state": "WI",
            "postal_code": "548019138",
            "telephone_number": "715-635-7204"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1661 HAMS RD",
            "city": "SPOONER",
            "state": "WI",
            "postal_code": "548019138",
            "telephone_number": "715-635-7204"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWEST PASSAGE - NORTHWEST PASSAGE II",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-20",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ELLIOT",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "PROGRAM DIRECTOR",
        "authorized_official_telephone_number": "715-327-4402"
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "WI",
            "license": "1004165",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF MN",
            "identifier": "3181NO",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "43015500",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Spooner, 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.