| 10th Street Comprehensive Treatment Center | |
|
4800 S. 10th Street Unit 1 Milwaukee WI 53221-2412 | |
| (414) 744-5370 | |
| (414) 744-9052 |
| Full Name | 10th Street Comprehensive Treatment Center |
|---|---|
| Speciality | Clinic/center - Methadone |
| Location | 4800 S. 10th Street, Milwaukee, Wisconsin |
| Authorized Official Name and Position | Brian Phillip Farley (VP & SECRETARY) |
| Authorized Official Contact | 6158616000 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| 10th Street Comprehensive Treatment Center 6183 Paseo Del Norte, Ste 200 Carlsbad CA 92011-1155 Ph: (855) 259-2288 | 10th Street Comprehensive Treatment Center 4800 S. 10th Street Unit 1 Milwaukee WI 53221-2412 Ph: (414) 744-5370 |
| NPI Number | 1790837128 |
|---|---|
| Provider Enumeration Date | 01/17/2007 |
| Last Update Date | 10/25/2024 |
| Certification Date | 10/25/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790837128 | NPI | - | NPPES |
| 42030200 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0802X | Psychiatry & Neurology - Addiction Psychiatry | 1644 (Wisconsin) | Secondary |
| 261QM2800X | Clinic/center - Methadone | 1644 (Wisconsin) | Primary |
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