| Brotoloc South, Inc. | |
|
209 S Taft St Whitewater WI 53190-2139 | |
| (262) 473-0480 | |
| (262) 473-0484 |
| Full Name | Brotoloc South, Inc. |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 209 S Taft St, Whitewater, Wisconsin |
| Authorized Official Name and Position | Nancy Schneider (DIRECTOR) |
| Authorized Official Contact | 2624730480 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Brotoloc South, Inc. 209 S Taft St Whitewater WI 53190-2139 Ph: (262) 473-0480 | Brotoloc South, Inc. 209 S Taft St Whitewater WI 53190-2139 Ph: (262) 473-0480 |
| NPI Number | 1407185325 |
|---|---|
| Provider Enumeration Date | 12/24/2009 |
| Last Update Date | 04/15/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407185325 | NPI | - | NPPES |
| 42181100 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | 1115 (Wisconsin) | Primary |
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