Healthcare Provider Details

I. General information

NPI: 1790972461
Provider Name (Legal Business Name): AJA CHILD & ADOLESCENT DAY TREATMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2007
Last Update Date: 09/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8726 W MILL RD
MILWAUKEE WI
53225-1838
US

IV. Provider business mailing address

8726 W MILL RD
MILWAUKEE WI
53225-1838
US

V. Phone/Fax

Practice location:
  • Phone: 414-353-9250
  • Fax: 414-353-2095
Mailing address:
  • Phone: 414-353-9250
  • Fax: 414-353-2095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number1205
License Number StateWI

VIII. Authorized Official

Name: MS. AREATHA MILLER
Title or Position: DIRECTOR
Credential: M.S.
Phone: 414-353-9250