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Organization

ERC WISCONSIN, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MARINA SHEPEL (CONTRACTING & CREDENTIALING MANAGER)
(425) 214-9321
Entity
Organization

Contact information

Practice address
2500 N MAYFAIR RD STE 600, WAUWATOSA, WI 53226-1428
(414) 727-4455
Mailing address
7351 E LOWRY BLVD SUITE #200, DENVER, CO 80256-1428
(414) 727-4455

Taxonomy

Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
261QM0855X
Adolescent and Children Mental Health Clinic/Center
283Q00000X
Psychiatric Hospital

Other

Enumeration date
08/03/2021
Last updated
02/03/2022
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