Healthcare Provider Details

I. General information

NPI: 1629282470
Provider Name (Legal Business Name): QUALITY ADDICTION MANAGEMENT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2357 W MASON ST
GREEN BAY WI
54303-4708
US

IV. Provider business mailing address

PO BOX 682669
FRANKLIN TN
37068-2669
US

V. Phone/Fax

Practice location:
  • Phone: 920-337-6740
  • Fax: 920-337-6741
Mailing address:
  • Phone: 760-710-0819
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1748
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number1748
License Number StateWI

VIII. Authorized Official

Name: BRIAN PHILLIP FARLEY
Title or Position: VP & SECRETARY
Credential:
Phone: 615-716-9335