OCONOMOWOC DEVEMOPMENTAL TRAINING CENTER LL (NPI# 1013240696) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1013240696 |
| Entity Type | Organization |
| Organization Name | OCONOMOWOC DEVEMOPMENTAL TRAINING CENTER LL |
| Other Organization Name | CORY HOUSE GROUP HOME |
| Practice Address |
201-203 Cory Ave. Dousman WI 53118 |
| Mailing Address |
Po Box 278 Dousman WI 53118 |
| Practice Telephone | 2625695515 |
| Practice Fax Number | 2625699962 |
| Mailing Telephone | 2625695515 |
| Mailing Fax Number | 2625699962 |
| Enumeration Date | 2009-09-14 |
| Last Update Date | 2009-09-14 |
| Authorized Official Name | MS. M. DEBORAH FRISK (VICE PRESIDENT) |
| Authorized Official Telephone | 2625695515 |
| Authorized Official Credential | MSW |
| Is Organization Subpart | Y |
| Parent Organization Name | OCONOMOWOC DEVEMOPMENTAL TRAINING CENTER LLC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 320600000X | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | WI | Residential Treatment Facilities |
| Other Name | Type Code |
|---|---|
| Cory House Group Home | Other Name - Individual/Organization |
| Street Address |
201-203 CORY AVE. |
| City | DOUSMAN |
| State | WI |
| Zip Code | 53118 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386977965 | Oconomowoc Development Training Center Ll | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 307 Wilson Ave., Dousman, WI 53118 | 2009-09-14 |
| 1184800880 | William M Buzogany | Psychiatry & Neurology | W350 S1401 Waterville Road, Lad Lake Inc, Dousman, WI 53118 | 2008-01-14 |
| 1821105313 | Carol J Lagerman | Nurse Practitioner | 370 Venture Dr, Dousman, WI 53118 | 2006-08-23 |
| 1235272212 | Dennis Mel Schaeffer | Dentist | 261 North Main Street, Dousman, WI 53118 | 2007-02-15 |
| 1003975046 | Steven A Donley | Chiropractor | 105 N Main St, Dousman, WI 53118 | 2006-12-06 |
| 1558499236 | Richard Vincent Whalen IIi | Dentist | 261 North Main Street, Dousman, WI 53118-0187 | 2007-03-02 |
| 1811025364 | Dousman Family Dentistry | Dentist | 261 N. Main Street, Dousman, WI 53118-0187 | 2007-02-28 |
| 1356749519 | Amy Vertz | Physical Therapy Assistant | 183 County Road D, Dousman, WI 53118-8737 | 2014-12-19 |
| 1629633862 | Sarah Margaret Ditorrice | Specialist/Technologist | 220 Zeck Ct, Dousman, WI 53118-8816 | 2019-05-02 |
| 1558439786 | Aurora Medical Group, Inc. | Durable Medical Equipment & Medical Supplies | 365 Sunset Dr, Dousman, WI 53118-8842 | 2006-12-04 |
| Find all providers in zip 53118 | ||||
| Taxonomy Code | 320600000X |
| Grouping | Residential Treatment Facilities |
| Classification | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities |
| A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental disabilities and/or mental retardation and are not able to live independently. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386977965 | Oconomowoc Development Training Center Ll | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 307 Wilson Ave., Dousman, WI 53118 | 2009-09-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093252140 | Apria Residential Inc. | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 2833 S 12th St, Sheboygan, WI 53081-6703 | 2017-01-27 |
| 1316482920 | Cheryl Mcmahon | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 2483 28th St, Rice Lake, WI 54868-9098 | 2017-01-05 |
| 1093174765 | Diane Cook | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 12489 State Highway 56, Viola, WI 54664-8914 | 2016-02-23 |
| 1467810788 | Stonebrick Residential Living Facility LLC | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 4703 W Villard Ave, Milwaukee, WI 53218-4459 | 2016-02-01 |
| 1932574670 | Gayle Millis | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 3260 E Carollton Dr, Oak Creek, WI 53154-4165 | 2015-12-07 |
| 1942605670 | Methu Adult Family Care Home II | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 2824 N 59th St, Milwaukee, WI 53210-1504 | 2014-10-23 |
| 1720498736 | Kaiser Adult Family Care, LLC | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | W782 Leroy St, Edgar, WI 54426-9627 | 2014-04-29 |
| 1851721344 | Evergreen Pines Inc | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 343 E Cumberland St, Berlin, WI 54923-1206 | 2013-11-19 |
| 1679913487 | Berlin Pines, Inc | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 642 Broadway, Berlin, WI 54923-1302 | 2013-06-26 |
| 1245502053 | Gloria Aweke | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 1111 Gas Light Dr, Sun Prairie, WI 53590-3459 | 2012-02-08 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.