Healthcare Provider Details

I. General information

NPI: 1265564678
Provider Name (Legal Business Name): SHOREHAVEN BEHAVIORAL HEALTH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2314 N GRANDVIEW SUITE 309
WAUKESHA WI
53188
US

IV. Provider business mailing address

3900 W BROWN DEER RD SUITE 200
BROWN DEER WI
53209
US

V. Phone/Fax

Practice location:
  • Phone: 414-540-2170
  • Fax: 414-540-2171
Mailing address:
  • Phone: 414-540-2170
  • Fax: 414-540-2171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State

VIII. Authorized Official

Name: MR. DON DAVID ROSENBERG
Title or Position: PRESIDENT
Credential: MS
Phone: 414-540-2170