Basic Information
| Provider Information | |||||||||
| NPI: | 1558609750 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CLINICARE CORPORATION - MILWAUKEE ACADEMY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10201 W LINCOLN AVE | ||||||||
| Address2: | |||||||||
| City: | WEST ALLIS | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532272136 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4142573141 | ||||||||
| FaxNumber: | 4142573151 | ||||||||
| Practice Location | |||||||||
| Address1: | 9501 W WATERTOWN PLANK RD | ||||||||
| Address2: | |||||||||
| City: | WAUWATOSA | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532263552 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4142573141 | ||||||||
| FaxNumber: | 4142573151 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/22/2013 | ||||||||
| LastUpdateDate: | 01/22/2013 | ||||||||
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| AuthorizedOfficialLastName: | CRIBBEN | ||||||||
| AuthorizedOfficialFirstName: | EVA | ||||||||
| AuthorizedOfficialMiddleName: | THERESE | ||||||||
| AuthorizedOfficialTitleorPosition: | PROGRAM THERAPIST | ||||||||
| AuthorizedOfficialTelephone: | 4142573141 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | MS | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 320800000X | 1178-226 | WI | Y | Residential Treatment Facilities | Community Based Residential Treatment Facility, Mental Illness |
No ID Information.