Healthcare Provider Details

I. General information

NPI: 1225284961
Provider Name (Legal Business Name): BALANCE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2008
Last Update Date: 04/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 S FOSTER DR
SAUKVILLE WI
53080-2005
US

IV. Provider business mailing address

134 S FOSTER DR
SAUKVILLE WI
53080-2005
US

V. Phone/Fax

Practice location:
  • Phone: 262-268-6811
  • Fax:
Mailing address:
  • Phone: 262-268-6811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. CRAIG R. MODAHL
Title or Position: EXECUTIVE DIRECTOR
Credential: CISW
Phone: 262-268-6811