Provider Demographics
NPI:1942465430
Name:HEALTHCARE CLINIC AND WELLNESS CENTER
Entity type:Organization
Organization Name:HEALTHCARE CLINIC AND WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:BESIADA-HANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:920-818-0424
Mailing Address - Street 1:51 W. WALNUT ST.
Mailing Address - Street 2:
Mailing Address - City:STURGEON BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54235
Mailing Address - Country:US
Mailing Address - Phone:920-818-0424
Mailing Address - Fax:
Practice Address - Street 1:835 POTTS AVE
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54304-4535
Practice Address - Country:US
Practice Address - Phone:920-491-9079
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-23
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization