OCONOMOWOC DEVELOPMENTAL TRAINING CENTER ODTC – NPI #1720117583
Residential Treatment Facility, Intellectual and/or Developmental Disabilities

A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental and intellectual disabilities and are not able to live independently.

Health Care Provider Taxonomy Code for Residential Treatment Facility, Intellectual and/or Developmental Disabilities

OCONOMOWOC DEVELOPMENTAL TRAINING CENTER ODTC is a residential treatment facility located in OCONOMOWOC, WI. NPPES has assigned the NPI number 1720117583 to OCONOMOWOC DEVELOPMENTAL TRAINING CENTER ODTC on March 05, 2007. It is a Type-2 NPI, indicating this NPI number is associated with an organization. Since the name “OCONOMOWOC DEVELOPMENTAL TRAINING CENTER ODTC” is a dba name, the actual legal business name for this organization is OCONOMOWOC DEVELOPMENTAL TRAINING CENTER OF WISCONSIN LLC. The primary taxonomy selected by this provider is 320600000X from the Health Care Provider Taxonomy code set, which is classified as Residential Treatment Facility, Intellectual and/or Developmental Disabilities.

The NPI profile was previously updated about 6 years ago on Aug 22, 2020. Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for OCONOMOWOC DEVELOPMENTAL TRAINING CENTER ODTC below.

NPI Profile for
OCONOMOWOC DEVELOPMENTAL TRAINING CENTER OF WISCONSIN LLC

NPI Number
1720117583
Enumeration Date

(more than 19 years ago)
Entity Type
Type-2  Organization
Organization health care providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.
Legal Name
OCONOMOWOC DEVELOPMENTAL TRAINING CENTER OF WISCONSIN LLC
Doing Business As (dba): OCONOMOWOC DEVELOPMENTAL TRAINING CENTER ODTC
Primary location
36100 GENESEE LAKE RD
OCONOMOWOC, WI 53066
Phone: (262) 569-5515 Fax: (262) 569-9962
Mailing address
PO BOX 278
DOUSMAN, WI 53118
Phone: (262) 569-5515 Fax: (262) 569-9962
Organization Subpart
No
Authorized Official
M FRISK
VICE PRESIDENT
Phone: (262) 569-5515
Updated
Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
320600000X
- Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Primary)		 WI

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.