Healthcare Provider Details

I. General information

NPI: 1912419136
Provider Name (Legal Business Name): FASD COMMUNITTIES DBA ALOHA COMMUNITY PLATTEVILLE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2017
Last Update Date: 10/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7296 BUNKER RIDGE RD
PLATTEVILLE WI
53818
US

IV. Provider business mailing address

7296 BUNKER RIDGE RD
PLATTEVILLE WI
53818
US

V. Phone/Fax

Practice location:
  • Phone: 715-252-7059
  • Fax:
Mailing address:
  • Phone: 715-252-7059
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name: JAMES DOUGLAS KLEIN
Title or Position: PROGRAM DIRECTOR
Credential: MSW
Phone: 715-252-7059