Healthcare Provider Details

I. General information

NPI: 1003413816
Provider Name (Legal Business Name): SBH-MADISON LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2020
Last Update Date: 10/29/2025
Certification Date: 10/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3169 DEMING WAY
MIDDLETON WI
53562-1435
US

IV. Provider business mailing address

3169 DEMING WAY
MIDDLETON WI
53562-1435
US

V. Phone/Fax

Practice location:
  • Phone: 901-969-3100
  • Fax:
Mailing address:
  • Phone: 608-716-8288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number
License Number State

VIII. Authorized Official

Name: PAUL GILBERT
Title or Position: CHIEF LEGAL OFFICER
Credential:
Phone: 615-716-4924