Organization
RIVER'S SHORE CLINIC CTC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LATEKA WASHINGTON (CLINICAL DIRECTOR)
(414) 967-7006
Entity
Organization
Contact information
Practice address
3707 N RICHARDS ST, MILWAUKEE, WI 53212-1673
(414) 967-7006
Mailing address
3707 N RICHARDS ST, MILWAUKEE, WI 53212-1673
(414) 967-7006
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
227113
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100056280
—
WI
Enumeration date
07/27/2016
Last updated
07/27/2016
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