MEDICARE: WESTCARE 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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1801544259
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WESTCARE WISCONSIN, INC

Provider Business Mailing Address
First Line	:	PO BOX 94738
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89193-4738
Country	:	US
Telephone Number	:	702-385-2090
Fax Number	:	702-977-5949

Provider Business Practice Location Address
First Line	:	2821 N VEL R PHILLIPS AVE STE 210
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53212-2370
Country	:	US
Telephone Number	:	414-263-6000
Fax Number	:	414-263-2270

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	TRAVIS LANDRY
Credential	:
Telephone Number	:	414-239-9359

Provider Enumeration Date	:	03/15/2022
Last Update Date	:	03/15/2022

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