Organization
HOPE HAVEN REBOS UNITED INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRUCE NICHOLAS MS.CSAC,ICS (DIRECTOR)
(608) 441-0204
Entity
Organization
Contact information
Practice address
810 W OLIN AVE, MADISON, WI 53715-2142
(608) 255-5922
(608) 255-0340
Mailing address
810 W OLIN AVE, MADISON, WI 53715-2142
(608) 255-5922
(608) 255-0340
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
1774
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1417112780
—
WI
Enumeration date
10/29/2012
Last updated
10/29/2012
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