# RED ROAD HOUSE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1023527769
- **Authorized official:** MISS WILLIAM GRAHN (FOUNDER/DIRECTOR)
- **Authorized official phone:** (608) 756-2592

## Contact information

- **Practice address:** 152 S LOCUST ST, JANESVILLE, WI 53548-3767
- **Practice address phone:** (608) 756-9252
- **Mailing address:** 152 S LOCUST ST, JANESVILLE, WI 53548-3767
- **Mailing address phone:** (608) 756-2592
- **Mailing address fax:** (608) 756-2592

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 405300000X | Prevention Professional | — | WI | Yes |

## Other

- **Enumeration date:** 09/26/2017
- **Last updated:** 06/11/2019

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0016168 | STATE OF WISCONSIN DEPARTMENT OF HEALTH SERVICES | WI |