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General NPI Number Information
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NPI Number | 1831464536
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Entity Type | Organization
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Legal Business Name | ALCOCARE INC.
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Dates
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Enumeration Date | 03/13/2012
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Last Update Date | 03/13/2012
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Provider Practice Location Address
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Address Line | 786 S MAIN ST
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City | JANESVILLE
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State | WI
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Zip | 53545-4852
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Country | US
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Telephone | 608-754-6800
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Fax | 608-754-2651
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Provider Business Mailing Address
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Address Line | 786 S MAIN ST
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City | JANESVILLE
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State | WI
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Zip | 53545-4852
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Country | US
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Telephone | 608-754-6800
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Fax | 608-754-2651
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. THOMAS SHANE BOLAN
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Credential | CAPSW
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Telephone | 608-751-1042
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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 | 1023
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License Number State | WI
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