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General NPI Number Information
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NPI Number | 1598186991
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Entity Type | Organization
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Legal Business Name | CAMPBELL HOUSE LLC
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Dates
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Enumeration Date | 01/02/2014
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Last Update Date | 01/02/2014
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Provider Practice Location Address
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Address Line | 7197 LOPER RD
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City | SAUK CITY
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State | WI
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Zip | 53583-9552
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Country | US
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Telephone | 608-643-3113
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Fax |
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Provider Business Mailing Address
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Address Line | 7197 LOPER RD
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City | SAUK CITY
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State | WI
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Zip | 53583-9552
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Country | US
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Telephone | 608-643-3113
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | GRETCHEN TIMMERMAN
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Credential |
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Telephone | 608-393-0707
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number | 0014785
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License Number State | WI
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