Provider Demographics
NPI:1568274298
Name:WELLBROOK RECOVERY MADISON LLC
Entity type:Organization
Organization Name:WELLBROOK RECOVERY MADISON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MEIR
Authorized Official - Middle Name:
Authorized Official - Last Name:KASNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-372-6643
Mailing Address - Street 1:13850 W CAPITOL DR
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-2422
Mailing Address - Country:US
Mailing Address - Phone:414-356-1418
Mailing Address - Fax:
Practice Address - Street 1:708 HEARTLAND TRL STE 3000
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53717-2174
Practice Address - Country:US
Practice Address - Phone:414-356-1418
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-21
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility