Healthcare Provider Details

I. General information

NPI: 1659912319
Provider Name (Legal Business Name): CORE TREATMENT SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2019
Last Update Date: 03/24/2025
Certification Date: 03/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 RIVERVIEW DR
MANITOWOC WI
54220-3767
US

IV. Provider business mailing address

PO BOX 1823
MANITOWOC WI
54221-1823
US

V. Phone/Fax

Practice location:
  • Phone: 920-645-1411
  • Fax:
Mailing address:
  • Phone: 920-663-1035
  • Fax: 920-320-1734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier100158506
Identifier TypeMEDICAID
Identifier StateWI
Identifier Issuer
# 2
Identifier100158503
Identifier TypeMEDICAID
Identifier StateWI
Identifier Issuer

VIII. Authorized Official

Name: CARMEN PERSAUD
Title or Position: CO-EXECUTIVE DIRECTOR
Credential: LPC CSAC ICS
Phone: 920-663-1035