MY INNOVATIVE SERVICES NPI 1790067890

NPI Information

  • NPI: 1790067890
  • Provider Name: MY INNOVATIVE SERVICES
  • Classification: Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities - 320900000X
  • Entity Type: Organization
  • Address: 445 S MADISON ST
    GREEN BAY, WI
    ZIP 54301
  • Phone: (920) 431-0962

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NPI Details

MY INNOVATIVE SERVICES is a community based residential treatment facility, intellectual and/or developmental disabilities in Green Bay, WI. The provider is a home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities. MY INNOVATIVE SERVICES NPI is 1790067890. The provider is registered as an organization entity type.

The provider's business location address is:

445 S MADISON ST
GREEN BAY, WI
ZIP 54301-126
Phone: (920) 431-0962
Fax: (920) 884-1967

The provider's authorized official is Marsha Renee Burklund .
The authorized official title is Controller and has the following contact phone number (920) 431-0962.

The enumeration date for this NPI number is 9/14/2011 and was last updated on 9/14/2011.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1320900000XCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities320900000XWISCONSINYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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