{"npi":"1235266065","type":"NPI-2","status":"active","name":{"display":"Northwest Passage Ltd","other":[],"organization_name":"NORTHWEST PASSAGE LTD","authorised_official":"Jackie Maurer"},"specialty":{"primary_taxonomy":"322D00000X","primary_taxonomy_description":"Emotionally Disturbed Childrens' Residential Treatment Facility","slug":"emotionally-disturbed-childrens-residential-treatment-facility","schema_org_specialty":null,"all":[{"code":"322D00000X","description":"Emotionally Disturbed Childrens' Residential Treatment Facility","primary":true,"state":"WI","license":"560014"}]},"addresses":[{"purpose":"LOCATION","street_1":"203 UNITED WAY DRIVE","city":"FREDERIC","state":"WI","postal_code":"548378938","country_code":"US","phone":"7153274402","fax":"7153274470"},{"purpose":"MAILING","street_1":"203 UNITED WAY DRIVE","city":"FREDERIC","state":"WI","postal_code":"548378938","country_code":"US","phone":"7153274322","fax":"7153278509"}],"license":{"state":"WI","number":"560014"},"identifiers":[{"type_code":"05","label":"Medicaid","value":"43015400","state":"WI","issuer":null},{"type_code":"01","label":"Other","value":"NONE","state":"WI","issuer":"HEALTH PARTNERS"},{"type_code":"01","label":"Other","value":"3181NO","state":"MN","issuer":"BCBS OF MN"}],"pecos":{"enrolled_at":null,"enrollments":[]},"enumeration_date":"2007-02-28","last_updated":"2012-03-27","_meta":{"source":"NPPES","snapshot_date":"2012-03-27","doc_url":"https://findmynpi.com/api"}}