Provider Demographics
NPI:1295872570
Name:NORTHREACH HEALTHCARE, LLC
Entity type:Organization
Organization Name:NORTHREACH HEALTHCARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF BUSINESS SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:HIPKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-732-2078
Mailing Address - Street 1:2026 CO. HWY. Q
Mailing Address - Street 2:
Mailing Address - City:POUND
Mailing Address - State:WI
Mailing Address - Zip Code:54143
Mailing Address - Country:US
Mailing Address - Phone:920-897-2331
Mailing Address - Fax:920-897-2115
Practice Address - Street 1:2026 COUNTY ROAD Q
Practice Address - Street 2:
Practice Address - City:POUND
Practice Address - State:WI
Practice Address - Zip Code:54161-9707
Practice Address - Country:US
Practice Address - Phone:920-897-2331
Practice Address - Fax:920-897-2115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty