Provider Demographics
NPI:1124094263
Name:SSM HEALTH TREATMENT AND RECOVERY CENTER
Entity type:Organization
Organization Name:SSM HEALTH TREATMENT AND RECOVERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:TROY
Authorized Official - Middle Name:L
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-356-1400
Mailing Address - Street 1:1510 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:BARABOO
Mailing Address - State:WI
Mailing Address - Zip Code:53913-1505
Mailing Address - Country:US
Mailing Address - Phone:608-356-1533
Mailing Address - Fax:
Practice Address - Street 1:1510 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:BARABOO
Practice Address - State:WI
Practice Address - Zip Code:53913-1505
Practice Address - Country:US
Practice Address - Phone:608-356-1533
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SSM HEALTH CARE OF WI INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-02-28
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilityGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI70OtherDEANCARE PROV #
WI391023846OtherCOMMERCIAL PROV #
WI549696OtherDC OUTPATIENT PROV #
WI391023846028OtherBLUE CROSS PROV #
WI1009390OtherPHYS PLUS PROV #
WI391023846028OtherBLUE CROSS PROV #