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General NPI Number Information
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NPI Number | 1821326455
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Entity Type | Organization
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Legal Business Name | WHITES RESIDENTIAL TREATMENT & CLINICAL SERVICES, INC.
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Dates
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Enumeration Date | 11/19/2009
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Last Update Date | 11/19/2009
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Provider Practice Location Address
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Address Line | 4020 W BURLEIGH ST
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City | MILWAUKEE
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State | WI
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Zip | 53210-1817
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Country | US
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Telephone | 414-445-7288
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Fax | 414-445-7708
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Provider Business Mailing Address
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Address Line | 6400 W CAPITOL DR SUITE 212
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City | MILWAUKEE
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State | WI
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Zip | 53216-2156
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Country | US
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Telephone | 414-536-7098
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Fax | 414-536-7106
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Authorized Official
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Title or Position | DIRECTOR
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Name | MRS. LANELL WHITE
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Credential | CCS
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Telephone | 414-536-7098
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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 | 2665
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License Number State | WI
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