Healthcare Provider Details

I. General information

NPI: 1932003308
Provider Name (Legal Business Name): UHS GREEN BAY OUD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

908 S FISK ST
GREEN BAY WI
54304-2214
US

IV. Provider business mailing address

908 S FISK ST
GREEN BAY WI
54304-2214
US

V. Phone/Fax

Practice location:
  • Phone: 274-207-9737
  • Fax:
Mailing address:
  • Phone: 274-207-9737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: STEVE FILTON
Title or Position: VICE PRESIDENT
Credential:
Phone: 610-382-3319