Healthcare Provider Details

I. General information

NPI: 1841831153
Provider Name (Legal Business Name): SHEBOYGAN COUNTY HALFWAY HOUSE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2019
Last Update Date: 04/20/2023
Certification Date: 04/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 ONTARIO AVE
SHEBOYGAN WI
53081-4151
US

IV. Provider business mailing address

503 ONTARIO AVE
SHEBOYGAN WI
53081-4151
US

V. Phone/Fax

Practice location:
  • Phone: 920-459-7673
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ERIK BUCHELT
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 920-459-7673