Healthcare Provider Details

I. General information

NPI: 1174798524
Provider Name (Legal Business Name): MILWAUKEE HEALTH SERVICES SYSTEM, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2008
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 S 10TH ST UNIT 1
MILWAUKEE WI
53221-2412
US

IV. Provider business mailing address

PO BOX 682669
FRANKLIN TN
37068-2669
US

V. Phone/Fax

Practice location:
  • Phone: 414-744-5370
  • Fax: 414-744-9052
Mailing address:
  • Phone: 760-710-0819
  • Fax: 414-744-9052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number1644
License Number StateWI

VIII. Authorized Official

Name: BRIAN PHILLIP FARLEY
Title or Position: VP & SECRETARY
Credential:
Phone: 615-861-6000