Provider Demographics
NPI:1104984558
Name:CLINICARE CORPORATION
Entity type:Organization
Organization Name:CLINICARE CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:SPECHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-326-6481
Mailing Address - Street 1:601 S BEAUMONT RD
Mailing Address - Street 2:PO BOX 269
Mailing Address - City:PRAIRIE DU CHIEN
Mailing Address - State:WI
Mailing Address - Zip Code:53821-1909
Mailing Address - Country:US
Mailing Address - Phone:608-326-6481
Mailing Address - Fax:608-326-6166
Practice Address - Street 1:601 S BEAUMONT RD
Practice Address - Street 2:
Practice Address - City:PRAIRIE DU CHIEN
Practice Address - State:WI
Practice Address - Zip Code:53821-1909
Practice Address - Country:US
Practice Address - Phone:608-326-6481
Practice Address - Fax:608-326-6166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children