Healthcare Provider Details

I. General information

NPI: 1558182527
Provider Name (Legal Business Name): LIFELINK BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2024
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 S EXECUTIVE DR # 2061
BROOKFIELD WI
53005-4216
US

IV. Provider business mailing address

200 S EXECUTIVE DR # 2061200S
BROOKFIELD WI
53005-4216
US

V. Phone/Fax

Practice location:
  • Phone: 414-800-9757
  • Fax: 414-710-2556
Mailing address:
  • Phone: 414-800-9757
  • Fax: 414-710-2556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MUSTAFA MOHAMED
Title or Position: DIRECTOR
Credential:
Phone: 414-882-1555