Organization
OPERATION FRESH START
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JIM SANDERS MS, LPC (DEPUTY DIRECTOR)
(608) 244-4721
Entity
Organization
Contact information
Practice address
1925 WINNEBAGO ST, MADISON, WI 53704-5314
(608) 244-4721
(608) 244-8162
Mailing address
1925 WINNEBAGO ST, MADISON, WI 53704-5314
(608) 244-4721
(608) 244-8162
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
70968030
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
41868000
MEDICARE PROVIDER CERTIFICATION
WI
Enumeration date
05/06/2008
Last updated
05/06/2008
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