Provider Demographics
NPI:1225202112
Name:MIDSTATE INDEPENDENT LIVING CHOICES, INC
Entity type:Organization
Organization Name:MIDSTATE INDEPENDENT LIVING CHOICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ZOE
Authorized Official - Middle Name:
Authorized Official - Last Name:NYLUND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-344-4210
Mailing Address - Street 1:3262 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:STEVENS POINT
Mailing Address - State:WI
Mailing Address - Zip Code:54481-5321
Mailing Address - Country:US
Mailing Address - Phone:715-344-4210
Mailing Address - Fax:715-344-4799
Practice Address - Street 1:3262 CHURCH ST
Practice Address - Street 2:
Practice Address - City:STEVENS POINT
Practice Address - State:WI
Practice Address - Zip Code:54481-5321
Practice Address - Country:US
Practice Address - Phone:715-344-4210
Practice Address - Fax:715-344-4799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-22
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
No253Z00000XAgenciesIn Home Supportive CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43113000Medicaid