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Organization Active NPI

Oconomowoc Developmental Training Center of Wisconsin LLC

  • Intellectual and/or Developmental Disabilities Residential Treatment Facility
  • Oconomowoc, WI
National Provider Identifier
1720117583
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X
Legal business name
OCONOMOWOC DEVELOPMENTAL TRAINING CENTER OF WISCONSIN LLC
Practice address
36100 Genesee Lake Rd
Oconomowoc, WI 53066
Phone
(262) 569-5515
Fax
(262) 569-9962
NPI assigned
Mar 5, 2007
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
Ms. M Deborah Frisk, MSW
Title
Vice President
Phone
(262) 569-5515

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual and/or Developmental Disabilities Residential Treatment Facility 320600000X WI Primary

Addresses

Primary practice location

36100 Genesee Lake Rd
Oconomowoc, WI 53066

Mailing address

PO Box 278
Dousman, WI 53118
Phone (262) 569-5515

Other names 1

  • Oconomowoc Developmental Training Center ODTC Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Oconomowoc Developmental Training Center of Wisconsin LLC5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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": "1173052800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1720117583",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 278",
            "city": "DOUSMAN",
            "state": "WI",
            "postal_code": "53118",
            "telephone_number": "262-569-5515",
            "fax_number": "262-569-9962"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "36100 GENESEE LAKE RD",
            "city": "OCONOMOWOC",
            "state": "WI",
            "postal_code": "53066",
            "telephone_number": "262-569-5515",
            "fax_number": "262-569-9962"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OCONOMOWOC DEVELOPMENTAL TRAINING CENTER OF WISCONSIN LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-05",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "FRISK",
        "authorized_official_first_name": "M",
        "authorized_official_middle_name": "DEBORAH",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "262-569-5515",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "MSW"
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "WI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Oconomowoc Developmental Training Center ODTC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Oconomowoc, 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.