Healthcare Provider Details

I. General information

NPI: 1144684697
Provider Name (Legal Business Name): MILWAUKEE HEALTH SERVICES SYSTEM, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2016
Last Update Date: 10/25/2024
Certification Date: 10/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3440 OAKWOOD HILLS PKWY
EAU CLAIRE WI
54701-7698
US

IV. Provider business mailing address

6183 PASEO DEL NORTE STE 200
CARLSBAD CA
92011-1155
US

V. Phone/Fax

Practice location:
  • Phone: 715-214-2525
  • Fax:
Mailing address:
  • Phone: 855-259-2288
  • Fax:

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 Code261QM2800X
TaxonomyMethadone Clinic
License Number
License Number State

VIII. Authorized Official

Name: BRIAN PHILLIP FARLEY
Title or Position: VP & SECRETARY
Credential:
Phone: 615-861-6000