Organization
SSM HEALTH TREATMENT AND RECOVERY CENTER
Active
Parent organization
SSM HEALTH CARE OF WI INC
Organization subpart
Yes
Provider details
NPI number
Legal business name
SSM HEALTH CARE OF WI INC
Authorized official
TROY L WALKER (DIRECTOR OF FINANCE)
(608) 356-1400
Entity
Organization
Contact information
Practice address
1510 JEFFERSON ST, BARABOO, WI 53913-1505
(608) 356-1533
Mailing address
1510 JEFFERSON ST, BARABOO, WI 53913-1505
(608) 356-1533
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
—
—
207R00000X
Internal Medicine Physician
—
—
261Q00000X
Clinic/Center
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
324500000X
Substance Abuse Rehabilitation Facility
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1009390
PHYS PLUS PROV #
WI
01
—
391023846
COMMERCIAL PROV #
WI
01
—
391023846028
BLUE CROSS PROV #
WI
01
—
549696
DC OUTPATIENT PROV #
WI
01
—
70
DEANCARE PROV #
WI
Enumeration date
02/28/2006
Last updated
05/09/2017
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