Organization
PREMIER CARE OF WISCONSIN, LLC.
Active
Other names
CMS WEST ALLIS
Organization subpart
No
Provider details
NPI number
Authorized official
CINDY GAITHER (VICE PRESIDENT REVENUE CYCLE MGMT)
(602) 248-8886
Entity
Organization
Contact information
Practice address
2814 S 108TH ST, WEST ALLIS, WI 53227-3224
(414) 885-3525
(262) 643-4617
Mailing address
8444 N 90TH ST STE 100, SCOTTSDALE, AZ 85258-4437
(160) 248-8886
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
251S00000X
Community/Behavioral Health Agency
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QM2800X
Methadone Clinic
Primary
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
—
Other
Enumeration date
12/13/2022
Last updated
02/10/2024
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