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General NPI Number Information
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NPI Number | 1447609029
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Entity Type | Organization
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Legal Business Name | SHEBOYGAN COMPREHENSIVE TREATMENT CENTER
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Dates
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Enumeration Date | 06/06/2016
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Last Update Date | 06/06/2016
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Provider Practice Location Address
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Address Line | 2842 S BUSINESS DR
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City | SHEBOYGAN
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State | WI
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Zip | 53081-6518
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Country | US
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Telephone | 920-458-6527
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Fax |
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Provider Business Mailing Address
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Address Line | W1781 PUDDLEFORT ST
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City | MOUNT CALVARY
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State | WI
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Zip | 53057-9714
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Country | US
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Telephone | 920-904-3533
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | CARY TAUCHMAN
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Credential | M.D.
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Telephone | 920-458-6527
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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 | 16934-130
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License Number State | WI
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