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General NPI Number Information
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NPI Number | 1518498047
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Entity Type | Organization
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Legal Business Name | TREATMENT PROVIDERS LLC
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Dates
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Enumeration Date | 03/26/2017
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Last Update Date | 12/19/2019
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Provider Practice Location Address
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Address Line | 2731 N PACKERLAND DR STE A
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City | GREEN BAY
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State | WI
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Zip | 54303
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Country | US
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Telephone | 920-770-5061
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Fax | 920-770-5467
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Provider Business Mailing Address
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Address Line | 2731 N PACKERLAND DR SUITE A
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City | GREEN BAY
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State | WI
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Zip | 54303-4855
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Country | US
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Telephone | 920-770-5061
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR/PARTNER
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Name | DR. ADEYEMI OLUDARE FATOKI
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Credential | MD
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Telephone | 920-770-5061
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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