Healthcare Provider Details

I. General information

NPI: 1427290402
Provider Name (Legal Business Name): EAU CLAIRE METRO TREATMENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2009
Last Update Date: 04/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 N OXFORD AVE STE 4
EAU CLAIRE WI
54703-5187
US

IV. Provider business mailing address

2000 N OXFORD AVE STE 4
EAU CLAIRE WI
54703-5187
US

V. Phone/Fax

Practice location:
  • Phone: 715-834-1078
  • Fax: 715-834-1218
Mailing address:
  • Phone: 715-834-1078
  • Fax: 715-834-1218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number15516130
License Number StateWI

VIII. Authorized Official

Name: NICOLE M BRADEN
Title or Position: COUNSELOR
Credential: SACIT
Phone: 715-834-1078