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General NPI Number Information
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NPI Number | 1245806264
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Entity Type | Organization
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Legal Business Name | BROADSTEP-WISCONSIN, INC.
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Dates
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Enumeration Date | 06/01/2021
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Last Update Date | 06/01/2021
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Provider Practice Location Address
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Address Line | 481 S CONCORD AVE
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City | WATERTOWN
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State | WI
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Zip | 53094-7307
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Country | US
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Telephone | 920-390-4435
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Fax | 920-390-4436
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Provider Business Mailing Address
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Address Line | 1205 S 70TH ST STE 202
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City | WEST ALLIS
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State | WI
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Zip | 53214-3167
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Country | US
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Telephone | 414-930-4421
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE ASSISTANT
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Name | JULIANNE YOPPS
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Credential |
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Telephone | 414-930-4421
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number |
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License Number State |
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