Provider Demographics
NPI:1386149052
Name:ANS CREATIVE BEHAVIORAL SERVICES II
Entity type:Organization
Organization Name:ANS CREATIVE BEHAVIORAL SERVICES II
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-481-9800
Mailing Address - Street 1:1551 S 108TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53214-4020
Mailing Address - Country:US
Mailing Address - Phone:414-481-9800
Mailing Address - Fax:414-481-9808
Practice Address - Street 1:1551 S 108TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53214-4020
Practice Address - Country:US
Practice Address - Phone:414-481-9800
Practice Address - Fax:414-481-9808
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANS CREATIVE BEHAVIORAL SOLUTIONS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-03-26
Last Update Date:2018-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1497119564Medicaid