Healthcare Provider Details

I. General information

NPI: 1871417055
Provider Name (Legal Business Name): INNER HAVEN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2026
Last Update Date: 09/27/2026
Certification Date: 09/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5500 W VLIET ST STE D
MILWAUKEE WI
53208-2120
US

IV. Provider business mailing address

5500 W VLIET ST
MILWAUKEE WI
53208-2120
US

V. Phone/Fax

Practice location:
  • Phone: 414-928-1414
  • Fax: 414-928-1415
Mailing address:
  • Phone: 414-928-1414
  • Fax: 414-928-1415

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN THOMAS OLSTAD
Title or Position: OWNER
Credential: APRN
Phone: 414-928-1414