Provider Demographics
NPI:1336247139
Name:MILWAUKEE HEALTH SERVICES SYSTEM, LLC
Entity type:Organization
Organization Name:MILWAUKEE HEALTH SERVICES SYSTEM, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP & SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:PHILLIP
Authorized Official - Last Name:FARLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-861-6000
Mailing Address - Street 1:6183 PASEO DEL NORTE
Mailing Address - Street 2:STE 200
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92011-1155
Mailing Address - Country:US
Mailing Address - Phone:855-259-2288
Mailing Address - Fax:
Practice Address - Street 1:210 WASHINGTON ST.
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54403-5475
Practice Address - Country:US
Practice Address - Phone:715-845-3637
Practice Address - Fax:715-845-1977
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ACADIA HEALTHCARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-20
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2408261QM2800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI10005631Medicaid
WI43030000Medicaid
WI39380300Medicaid
WI43701100Medicaid
WI34657600Medicaid
WI39350000Medicaid
WI42024500Medicaid
WI42020800Medicaid
WI42229200Medicaid
WI42015800Medicaid