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General NPI Number Information
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NPI Number | 1790088896
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Entity Type | Organization
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Legal Business Name | META HOUSE
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Dates
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Enumeration Date | 12/10/2010
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Last Update Date | 12/10/2010
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Provider Practice Location Address
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Address Line | 2618 N BREMEN ST
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City | MILWAUKEE
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State | WI
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Zip | 53212-3003
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Country | US
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Telephone | 414-962-1200
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Fax | 414-372-9287
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Provider Business Mailing Address
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Address Line | 2618 N BREMEN ST
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City | MILWAUKEE
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State | WI
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Zip | 53212-3003
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Country | US
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Telephone | 414-962-1200
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Fax | 414-372-9287
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Authorized Official
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Title or Position | DIRECTOR OF PROGRAMS
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Name | MS. CHRISTINE ANN ULLSTRUP
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Credential | LCSW, CSAC, ICS
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Telephone | 414-977-5871
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State | WI
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