=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093609919
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MANY ROADS CLINIC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/05/2025
-----------------------------------------------------
Last Update Date | 06/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9130 W LOOMIS RD STE 950
-----------------------------------------------------
City | FRANKLIN
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53132-7711
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-975-8106
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2510 E CAPITOL DR
-----------------------------------------------------
City | SHOREWOOD
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53211-2136
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-975-8106
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JOSEPH GRECO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 414-975-8106
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------