Organization
RETRAC ENTERPRISES INC
Active
Other names
RETRAC Enterprises INC
Organization subpart
No
Provider details
NPI number
Authorized official
AMBER ELLIS PHYSICIAN ASSISTANT (OWNER)
(414) 218-8670
Entity
Organization
Contact information
Practice address
4117 N GREEN BAY AVE, MILWAUKEE, WI 53209-7019
(414) 433-0780
(414) 433-5780
Mailing address
4117 N GREEN BAY AVE, MILWAUKEE, WI 53209-7019
(414) 218-8670
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
3104A0625X
Assisted Living Facility (Mental Illness)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1760613327
—
WI
Enumeration date
04/05/2022
Last updated
09/02/2025
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