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Organization
STATE OF WISCONSIN
Active
Organization
STATE OF WISCONSIN
Active
Other names
Mendota Mental Health Institute
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GREG J VAN RYBROECK PHD JD (DIRECTOR)
(608) 301-1042
Entity
Organization
Contact information
Practice address
301 TROY DR, MADISON, WI 53704-1521
(608) 301-1000
(608) 301-1390
Mailing address
301 TROY DR, MADISON, WI 53704-1521
(608) 301-1000
(608) 301-1390
Taxonomy
Speciality
Code
Description
License number
State
282N00000X
General Acute Care Hospital
Primary
283Q00000X
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10063400
—
WI
Enumeration date
09/08/2006
Last updated
06/26/2008
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