Organization
EAU CLAIRE ACADEMY HC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHARLES LEE ALBRENT M.P.A. (EXECUTIVE DIRECTOR)
(715) 834-6681
Entity
Organization
Contact information
Practice address
550 N DEWEY ST, EAU CLAIRE, WI 54703-3218
(715) 834-6681
(715) 834-9954
Mailing address
550 N DEWEY ST, EAU CLAIRE, WI 54703-3218
(715) 834-6681
(715) 834-9954
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
560002
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
43015000
—
WI
Enumeration date
05/01/2008
Last updated
05/01/2008
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