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General NPI Number Information
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NPI Number | 1306123070
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Entity Type | Organization
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Legal Business Name | COULEE COUNCIL ON ADDICTIONS
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Dates
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Enumeration Date | 11/09/2011
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Last Update Date | 11/09/2011
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Provider Practice Location Address
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Address Line | 921 WEST AVE S
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City | LA CROSSE
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State | WI
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Zip | 54601-4745
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Country | US
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Telephone | 608-784-4177
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Fax | 608-784-6302
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Provider Business Mailing Address
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Address Line | 921 WEST AVE S
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City | LA CROSSE
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State | WI
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Zip | 54601-4745
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Country | US
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Telephone | 608-784-4177
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Fax | 608-784-6302
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | PATRICIA RUDA
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Credential |
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Telephone | 608-784-4177
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 1240
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License Number State | WI
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