=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548345150
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOUTHWEST HEALTH CENTER, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/25/2006
-----------------------------------------------------
Last Update Date | 12/17/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1400 EASTSIDE RD
-----------------------------------------------------
City | PLATTEVILLE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53818-9800
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-348-2331
-----------------------------------------------------
Fax | 608-342-4713
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1400 EASTSIDE RD
-----------------------------------------------------
City | PLATTEVILLE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53818-9800
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-348-2331
-----------------------------------------------------
Fax | 608-342-4713
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DANIEL ROHRBACH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 608-348-2331
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 273R00000X
-----------------------------------------------------
Taxonomy Name | Psychiatric Hospital Unit
-----------------------------------------------------
License Number | 1063
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------