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NPI Code Detail

MEDICARE: META HOUSE

MEDICARE: META HOUSE
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
1324500000XSubstance Abuse Rehabilitation FacilityWI

General Provider Information

NPI Number : 1790088896
Entity Type Code : Organization
Provider Name (Legal Business Name) : META HOUSE
Provider Business Mailing Address
First Line : 2618 N BREMEN ST
Second Line :
City : MILWAUKEE
State : WI
Zip : 53212-3003
Country : US
Telephone Number : 414-962-1200
Fax Number : 414-372-9287
Provider Business Practice Location Address
First Line : 2618 N BREMEN ST
Second Line :
City : MILWAUKEE
State : WI
Zip : 53212-3003
Country : US
Telephone Number : 414-962-1200
Fax Number : 414-372-9287
Authorized Official
Title or Position : DIRECTOR OF PROGRAMS
Name : MS. CHRISTINE ANN ULLSTRUP
Credential : LCSW, CSAC, ICS
Telephone Number : 414-977-5871
Provider Enumeration Date : 12/10/2010
Last Update Date : 12/10/2010

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1790069557 — META HOUSE, INC.
Practice Location Address:
2626 N BREMEN ST
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Practice Phone: 414-977-5862
Practice Fax: 414-372-9287

Directions to “META HOUSE ” Practice Location

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