NPIMap

Organization Active NPI

Northwest Passage LTD

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Webster, WI
National Provider Identifier
1639294168
Registry record updated Mar 27, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X
License
560014 Issued in WI
Legal business name
NORTHWEST PASSAGE LTD
Practice address
7818 Moline Road
Webster, WI 54893-8545
Phone
(715) 866-8301
Fax
(715) 866-8374
NPI assigned
Mar 21, 2007
Last updated
Mar 27, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 27, 2012

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

Authorized official

Name
Jackie J Maurer
Title
Business Office Supervisor
Phone
(715) 327-4322

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X 560014 WI Primary

Addresses

Primary practice location

7818 Moline Road
Webster, WI 54893-8545

Mailing address

203 United Way Drive
Frederic, WI 54837-8938
Phone (715) 327-4322

Other identifiers 2

IdentifierTypeStateIssuer
3181NOOtherMNBCBS OF MN
43015300MedicaidWI

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.

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

NPI Registry JSON

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

{
    "created_epoch": "1174435200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1332806400000",
    "number": "1639294168",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "203 UNITED WAY DRIVE",
            "city": "FREDERIC",
            "state": "WI",
            "postal_code": "548378938",
            "telephone_number": "715-327-4322",
            "fax_number": "715-327-8509"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7818 MOLINE ROAD",
            "city": "WEBSTER",
            "state": "WI",
            "postal_code": "548938545",
            "telephone_number": "715-866-8301",
            "fax_number": "715-866-8374"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWEST PASSAGE LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-21",
        "last_updated": "2012-03-27",
        "status": "A",
        "authorized_official_last_name": "MAURER",
        "authorized_official_first_name": "JACKIE",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "BUSINESS OFFICE SUPERVISOR",
        "authorized_official_telephone_number": "715-327-4322"
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "WI",
            "license": "560014",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF MN",
            "identifier": "3181NO",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "43015300",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Webster, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2012; 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.