Organization
WISCONSIN RECOVERY INSTITUTE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACOB EDELSTEIN (OWNER)
(949) 245-8625
Entity
Organization
Contact information
Practice address
1446 LYNN AVE, FOND DU LAC, WI 54937-6900
(920) 990-2104
Mailing address
1446 LYNN AVE, FOND DU LAC, WI 54937-6900
(920) 990-2104
Taxonomy
Speciality
Code
Description
License number
State
276400000X
Substance Use Disorder Rehabilitation Hospital Unit
—
—
323P00000X
Psychiatric Residential Treatment Facility
—
—
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Enumeration date
04/23/2024
Last updated
04/23/2024
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