Provider Demographics
NPI:1538790324
Name:OOBOODASH CARES WELLNESS SERVICES LLC
Entity type:Organization
Organization Name:OOBOODASH CARES WELLNESS SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:A
Authorized Official - Last Name:CORMELL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW SAC
Authorized Official - Phone:715-699-0026
Mailing Address - Street 1:PO BOX 504
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:WI
Mailing Address - Zip Code:54843-0504
Mailing Address - Country:US
Mailing Address - Phone:715-699-0026
Mailing Address - Fax:715-934-2101
Practice Address - Street 1:10576 MAIN STREET
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:WI
Practice Address - Zip Code:54843-6658
Practice Address - Country:US
Practice Address - Phone:715-699-0026
Practice Address - Fax:715-934-2101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-30
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100095789Medicaid