MEDICARE: BROADSTEP-WISCONSIN, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1073706420
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BROADSTEP-WISCONSIN, INC.

Provider Business Mailing Address
First Line	:	5551 N. 51ST BLVD.
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53218
Country	:	US
Telephone Number	:	414-527-6970
Fax Number	:	414-527-6971

Provider Business Practice Location Address
First Line	:	7830 W SILVER SPRING DR
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53218-2610
Country	:	US
Telephone Number	:	414-464-6469
Fax Number	:	414-464-6470

Authorized Official
Title or Position	:	EXECUTIVE ASSISTANT
Name	:	JULIANNE YOPPS
Credential	:
Telephone Number	:	414-930-4421

Provider Enumeration Date	:	08/20/2007
Last Update Date	:	05/19/2021

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