MEDICARE: BROADSTEP-WISCONSIN, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320800000X	Mental Illness Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1427241645
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BROADSTEP-WISCONSIN, INC.

Provider Business Mailing Address
First Line	:	2858 S 68TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53219-2903
Country	:	US
Telephone Number	:	414-327-7510
Fax Number	:	414-327-7569

Provider Business Practice Location Address
First Line	:	2558 SOUTH 68TH STREET
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53219
Country	:	US
Telephone Number	:	414-327-7510
Fax Number	:	414-327-7569

Authorized Official
Title or Position	:	EXECUTIVE ASSISTANT
Name	:	JULIANNE YOPPS
Credential	:
Telephone Number	:	414-930-4421

Provider Enumeration Date	:	08/21/2007
Last Update Date	:	04/28/2021

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Directions to “BROADSTEP-WISCONSIN, INC. ” Practice Location

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