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General NPI Number Information
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NPI Number | 1841964970
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Entity Type | Organization
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Legal Business Name | WISCONSIN COMMUNITY SERVICES, INC-JOSHUA GLOVER RRC
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Dates
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Enumeration Date | 08/03/2021
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Last Update Date | 02/13/2024
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Provider Practice Location Address
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Address Line | 2404 N 50TH ST
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City | MILWAUKEE
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State | WI
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Zip | 53210-2814
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Country | US
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Telephone | 414-442-3700
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Fax |
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Provider Business Mailing Address
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Address Line | 2404 N 50TH ST
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City | MILWAUKEE
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State | WI
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Zip | 53210-2814
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Country | US
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Telephone | 414-442-3700
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Fax |
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Authorized Official
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Title or Position | PROGRAM DIRECTOR
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Name | JOY FITZSIMONS
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Credential |
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Telephone | 414-442-3700
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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 |
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