Healthcare Provider Details

I. General information

NPI: 1801544259
Provider Name (Legal Business Name): WESTCARE WISCONSIN, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2022
Last Update Date: 03/15/2022
Certification Date: 03/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2821 N VEL R PHILLIPS AVE STE 210
MILWAUKEE WI
53212-2370
US

IV. Provider business mailing address

PO BOX 94738
LAS VEGAS NV
89193-4738
US

V. Phone/Fax

Practice location:
  • Phone: 414-263-6000
  • Fax: 414-263-2270
Mailing address:
  • Phone: 702-385-2090
  • Fax: 702-977-5949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: TRAVIS LANDRY
Title or Position: VICE PRESIDENT
Credential:
Phone: 414-239-9359