| Milwaukee County Behavioral Health Community Support Program Southside | |
|
9455 W Watertown Plank Rd Milwaukee WI 53226-3559 | |
| (414) 257-6995 | |
| Not Available |
| Full Name | Milwaukee County Behavioral Health Community Support Program Southside |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 9455 W Watertown Plank Rd, Milwaukee, Wisconsin |
| Authorized Official Name and Position | James Kubicek (ACTING HOSPITAL ADMISINTRATOR) |
| Authorized Official Contact | 4142574823 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Milwaukee County Behavioral Health Community Support Program Southside 9455 W Watertown Plank Rd Milwaukee WI 53226-3559 Ph: (414) 257-6995 | Milwaukee County Behavioral Health Community Support Program Southside 9455 W Watertown Plank Rd Milwaukee WI 53226-3559 Ph: (414) 257-6995 |
| NPI Number | 1093973141 |
|---|---|
| Provider Enumeration Date | 05/27/2008 |
| Last Update Date | 04/24/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093973141 | NPI | - | NPPES |
| 00812 | Other | WI | MEDICARE ID |
| 43420800 | Medicaid | WI | |
| 43421000 | Other | WI | MEDICAID PERFORMING PROVIDER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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