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General NPI Number Information
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NPI Number | 1538634829
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Entity Type | Organization
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Legal Business Name | 4TH DIMENSION RECOVERY CENTERS
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Dates
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Enumeration Date | 10/12/2018
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Last Update Date | 10/10/2024
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Provider Practice Location Address
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Address Line | 1216 N PROSPECT AVE
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City | MILWAUKEE
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State | WI
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Zip | 53202-3061
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Country | US
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Telephone | 973-277-5359
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Fax | 928-441-1686
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Provider Business Mailing Address
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Address Line | 1216 N PROSPECT AVE
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City | MILWAUKEE
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State | WI
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Zip | 53202-3061
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Country | US
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Telephone | 973-277-5359
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Fax |
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Authorized Official
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Title or Position | CHIEF OPERATIONS OFFICER
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Name | JASON LEE LUELL
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Credential |
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Telephone | 414-406-7852
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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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 | 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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