NPIMap

Organization Active NPI

Maehnowesekiyah Wellness Center

  • Community/Behavioral Health Agency
  • Gresham, WI
National Provider Identifier
1497910103
Registry record updated Aug 9, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
1554 Issued in WI
Legal business name
MAEHNOWESEKIYAH WELLNESS CENTER
Practice address
N2150 Kesaehkahtek Rd
Gresham, WI 54128-9602
Phone
(715) 799-3835
Fax
(715) 799-3836
NPI assigned
Jul 22, 2008
Last updated
Aug 9, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 9, 2022

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

Authorized official

Name
Addie Mae Caldwell, MA, LPC
Title
Director of Wellness Programs
Phone
(715) 799-3835

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X 1554 WI Primary

Addresses

Primary practice location

N2150 Kesaehkahtek Rd
Gresham, WI 54128-9602

Mailing address

N2150 Kesaehkahtek Rd
Gresham, WI 54128-9602
Phone (715) 799-3835

Other identifiers 1

IdentifierTypeStateIssuer
42151300MedicaidWI

National Provider Directory

National Provider Directory
Tax ID family
Menominee Tribal Clinic7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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

Locations

N2150 Kesaehkahtek Rd
Gresham, WI 54128
Phone (715) 799-3835

NPI Registry JSON

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

{
    "created_epoch": "1216684800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1660003200000",
    "number": "1497910103",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "N2150 KESAEHKAHTEK RD",
            "city": "GRESHAM",
            "state": "WI",
            "postal_code": "541289602",
            "telephone_number": "715-799-3835",
            "fax_number": "715-799-3836"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "N2150 KESAEHKAHTEK RD",
            "city": "GRESHAM",
            "state": "WI",
            "postal_code": "541289602",
            "telephone_number": "715-799-3835",
            "fax_number": "715-799-3836"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAEHNOWESEKIYAH WELLNESS CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-22",
        "last_updated": "2022-08-09",
        "certification_date": "2022-08-09",
        "status": "A",
        "authorized_official_last_name": "CALDWELL",
        "authorized_official_first_name": "ADDIE",
        "authorized_official_middle_name": "MAE",
        "authorized_official_title_or_position": "DIRECTOR OF WELLNESS PROGRAMS",
        "authorized_official_telephone_number": "715-799-3835",
        "authorized_official_credential": "MA, LPC"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "WI",
            "license": "1554",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "42151300",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gresham, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2022; 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.