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General NPI Number Information
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NPI Number | 1356907133
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Entity Type | Organization
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Legal Business Name | RGN FAMILY BEHAVIORAL HEALTH, LLC
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Dates
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Enumeration Date | 05/16/2019
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Last Update Date | 05/16/2019
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Provider Practice Location Address
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Address Line | 6917 W OKLAHOMA AVE
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City | MILWAUKEE
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State | WI
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Zip | 53219-2973
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Country | US
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Telephone | 414-545-7425
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Fax |
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Provider Business Mailing Address
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Address Line | 6917 W OKLAHOMA AVE
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City | MILWAUKEE
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State | WI
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Zip | 53219-2973
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Country | US
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Telephone | 414-545-7425
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING COORDINATE
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Name | MR. DAVID JOHN GUMAN
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Credential |
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Telephone | 414-434-0908
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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