Provider Demographics
NPI:1992980403
Name:THE INSTITUTE FOR COLLABORATIVE HEALTH INTERVENTIONS, INC.
Entity type:Organization
Organization Name:THE INSTITUTE FOR COLLABORATIVE HEALTH INTERVENTIONS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:FREDIANI
Authorized Official - Suffix:
Authorized Official - Credentials:MHA
Authorized Official - Phone:414-791-0813
Mailing Address - Street 1:2941 N PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53211-3345
Mailing Address - Country:US
Mailing Address - Phone:414-791-0813
Mailing Address - Fax:
Practice Address - Street 1:2941 N PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53211-3345
Practice Address - Country:US
Practice Address - Phone:414-791-0813
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-02
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41222200Medicaid