Provider Demographics
NPI:1871049486
Name:CAREATC - ANDES CANDIES
Entity type:Organization
Organization Name:CAREATC - ANDES CANDIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PURCHASING AND FACILITI
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:GUCWA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-779-7416
Mailing Address - Street 1:1400 E. EISCONSIN
Mailing Address - Street 2:
Mailing Address - City:DELAVAN
Mailing Address - State:WI
Mailing Address - Zip Code:53115
Mailing Address - Country:US
Mailing Address - Phone:918-779-7416
Mailing Address - Fax:855-346-7414
Practice Address - Street 1:1400 E. EISCONSIN
Practice Address - Street 2:
Practice Address - City:DELAVAN
Practice Address - State:WI
Practice Address - Zip Code:53115
Practice Address - Country:US
Practice Address - Phone:918-779-7416
Practice Address - Fax:855-346-7414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care