Provider Demographics
NPI:1386343820
Name:STOTTS MEDICAL AND MENTAL HEALTH SERVICES, LLC
Entity type:Organization
Organization Name:STOTTS MEDICAL AND MENTAL HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:J HILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-509-6084
Mailing Address - Street 1:5600 W FOND DU LAC AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53216-1222
Mailing Address - Country:US
Mailing Address - Phone:414-509-6084
Mailing Address - Fax:
Practice Address - Street 1:5600 W FOND DU LAC AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53216-1222
Practice Address - Country:US
Practice Address - Phone:414-509-6084
Practice Address - Fax:414-509-6885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-23
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No163WC1500XNursing Service ProvidersRegistered NurseCommunity HealthGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral Health