Healthcare Provider Details

I. General information

NPI: 1699968032
Provider Name (Legal Business Name): BROADSTEP-WISCONSIN, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2007
Last Update Date: 04/28/2021
Certification Date: 04/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7401 W FLORIST AVE
MILWAUKEE WI
53218-1850
US

IV. Provider business mailing address

7401 W FLORIST AVE
MILWAUKEE WI
53218-1850
US

V. Phone/Fax

Practice location:
  • Phone: 414-438-1820
  • Fax: 414-438-6788
Mailing address:
  • Phone: 414-438-1820
  • Fax: 414-438-6788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: JULIANNE YOPPS
Title or Position: EXECUTIVE ASSISTANT
Credential:
Phone: 414-930-4421