Provider Demographics
NPI:1992939383
Name:EAU CLAIRE METRO TREATMENT CENTER
Entity type:Organization
Organization Name:EAU CLAIRE METRO TREATMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:DESIREE
Authorized Official - Middle Name:
Authorized Official - Last Name:FRANCE
Authorized Official - Suffix:
Authorized Official - Credentials:SACIT
Authorized Official - Phone:715-834-1078
Mailing Address - Street 1:2000 N OXFORD AVE
Mailing Address - Street 2:BOX 4
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54703-5184
Mailing Address - Country:US
Mailing Address - Phone:715-834-1078
Mailing Address - Fax:715-834-1218
Practice Address - Street 1:2000 N OXFORD AVE
Practice Address - Street 2:BOX 4
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54703-5184
Practice Address - Country:US
Practice Address - Phone:715-834-1078
Practice Address - Fax:715-834-1218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-13
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15699130251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI15699130OtherSTATE OF WI DEPT. OF REG. AND LICENSING