Healthcare Provider Details

I. General information

NPI: 1730372186
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: 05/19/2021
Certification Date: 04/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1141 N 46TH ST
MILWAUKEE WI
53208-2702
US

IV. Provider business mailing address

1141 N 46TH ST
MILWAUKEE WI
53208-2702
US

V. Phone/Fax

Practice location:
  • Phone: 414-344-1993
  • Fax: 414-344-5509
Mailing address:
  • Phone: 414-344-1993
  • Fax: 414-344-5509

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