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General NPI Number Information
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NPI Number | 1982933503
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Entity Type | Organization
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Legal Business Name | BROTOLOC SOUTH, INC.
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Dates
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Enumeration Date | 12/10/2009
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Last Update Date | 04/26/2010
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Provider Practice Location Address
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Address Line | 5812 W BURNHAM ST
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City | WEST ALLIS
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State | WI
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Zip | 53219-1524
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Country | US
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Telephone | 414-543-3200
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Fax | 414-543-3269
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Provider Business Mailing Address
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Address Line | 5812 W BURNHAM ST
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City | WEST ALLIS
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State | WI
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Zip | 53219-1524
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Country | US
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Telephone | 414-543-3200
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Fax | 414-543-3269
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Authorized Official
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Title or Position | DIRECTOR
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Name | DOUG E SVEDA
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Credential |
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Telephone | 414-543-3200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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