Organization
RED ROAD HOUSE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS WILLIAM GRAHN (FOUNDER/DIRECTOR)
(608) 756-2592
Entity
Organization
Contact information
Practice address
152 S LOCUST ST, JANESVILLE, WI 53548-3767
(608) 756-9252
Mailing address
152 S LOCUST ST, JANESVILLE, WI 53548-3767
(608) 756-2592
(608) 756-2592
Taxonomy
Speciality
Code
Description
License number
State
405300000X
Prevention Professional
Primary
—
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0016168
STATE OF WISCONSIN DEPARTMENT OF HEALTH SERVICES
WI
Enumeration date
09/26/2017
Last updated
06/11/2019
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