MEDICARE: RETRAC ENTERPRISES 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	3104A0625X	Assisted Living Facility (Mental Illness)
2	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306587167
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RETRAC ENTERPRISES INC

Provider Business Mailing Address
First Line	:	4117 N GREEN BAY AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53209-7019
Country	:	US
Telephone Number	:	414-218-8670
Fax Number	:

Provider Business Practice Location Address
First Line	:	4117 N GREEN BAY AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53209-7019
Country	:	US
Telephone Number	:	414-433-0780
Fax Number	:	414-433-5780

Authorized Official
Title or Position	:	OWNER
Name	:	AMBER ELLIS
Credential	:	PHYSICIAN ASSISTANT
Telephone Number	:	414-218-8670

Provider Enumeration Date	:	04/05/2022
Last Update Date	:	09/02/2025

Similar Medicare Providers

1922955608 — QUALITY LIVING HOME HEALTH CARE
Practice Location Address:

4117 N GREEN BAY AVE STE 3
MILWAUKEE, WI
53209-7019

Practice Phone: 414-232-4886
Practice Fax: 414-433-5780

1760613327 — AMBER WARD PA
Practice Location Address:

4117 N GREEN BAY AVE
MILWAUKEE, WI
53209-7019

Practice Phone: 414-218-8670
Practice Fax:

1053510115 — PETRE IOSIF WECSLER M.D.
Practice Location Address:

7019 N BARNETT LN
MILWAUKEE, WI
53217-3606

Practice Phone: 414-228-7268
Practice Fax:

1679429872 — PROLIFIC CARE HOMES 2 LLC
Practice Location Address:

3909 W GOOD HOPE RD
MILWAUKEE, WI
53209-2334

Practice Phone: 262-613-0816
Practice Fax: 262-613-0816

1144176124 — NICOLE THOMPSON PASS TRAINING
Practice Location Address:

5715 N 37TH ST
MILWAUKEE, WI
53209-4015

Practice Phone: 414-326-6575
Practice Fax:

1447107347 — DIVERSE CARE SERVICES LLC
Practice Location Address:

4950 N 21ST ST
MILWAUKEE, WI
53209-5750

Practice Phone: 414-242-2627
Practice Fax:

Directions to “RETRAC ENTERPRISES INC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.