Organization
RIVER'S SHORE CLINIC
Active
Other names
CRC Healthcare
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DEBRA JEAN DANOSKI CSAC, ICS (CLINIC DIRECTOR)
(414) 967-7006
Entity
Organization
Contact information
Practice address
3707 N RICHARDS ST, MILWAUKEE, WI 53212-1673
(414) 967-7006
(414) 967-7020
Mailing address
3707 N RICHARDS ST, MILWAUKEE, WI 53212-1673
(414) 967-7006
(414) 967-7020
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
1643
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DJKF54
TAXONOMY NUMBER - 261QM0801X
WI
Enumeration date
07/15/2013
Last updated
07/15/2013
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