Organization
BROADSTEP-WISCONSIN, INC.
Active
Other names
Fairfield
Organization subpart
No
Provider details
NPI number
Authorized official
JULIANNE YOPPS (EXECUTIVE ASSISTANT)
(414) 930-4421
Entity
Organization
Contact information
Practice address
1408 FAIRFIELD CT, WATERTOWN, WI 53098-3418
(920) 206-1192
(920) 206-1409
Mailing address
1205 S 70TH ST STE 202, WEST ALLIS, WI 53214-3167
(414) 930-4421
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
—
—
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
—
Other
Enumeration date
06/01/2021
Last updated
06/01/2021
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