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312 E Wisconsin Ave Milwaukee WI 53202-4310 | |
| (714) 828-1800 | |
| (714) 882-1186 |
| Full Name | |
|---|---|
| Speciality | Psychiatric Residential Treatment Facility |
| Location | 312 E Wisconsin Ave, Milwaukee, Wisconsin |
| Authorized Official Name and Position | Magdalen Gustilo (DIRECTOR OF PAYER RELATIONS) |
| Authorized Official Contact | 7145687667 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
18401 Von Karman Ave Ste 500 Irvine CA 92612-8531 Ph: (714) 828-1800 | 312 E Wisconsin Ave Milwaukee WI 53202-4310 Ph: (714) 828-1800 |
| NPI Number | 1366109829 |
|---|---|
| Provider Enumeration Date | 11/19/2021 |
| Last Update Date | 07/03/2023 |
| Certification Date | 07/03/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366109829 | NPI | - | NPPES |
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