Provider Demographics
NPI:1902501208
Name:IRIS HEALTH CLINIC
Entity type:Organization
Organization Name:IRIS HEALTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUNZELLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-420-9088
Mailing Address - Street 1:255 W BROADWAY
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53186-4832
Mailing Address - Country:US
Mailing Address - Phone:262-420-9088
Mailing Address - Fax:
Practice Address - Street 1:E401 23RD ST
Practice Address - Street 2:
Practice Address - City:BRODHEAD
Practice Address - State:WI
Practice Address - Zip Code:53520-2203
Practice Address - Country:US
Practice Address - Phone:262-420-9088
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-04
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility