Organization
MARQUETTE CHEMICAL DEPENDENCY SERVICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRUCE NICHOLAS (SUPERVISOR FOR MCDS)
(608) 441-0204
Entity
Organization
Contact information
Practice address
N3829 STATE ROAD 22, MONTELLO, WI 53949-9049
(608) 297-2085
(608) 297-2426
Mailing address
N3829 STATE ROAD 22, PO BOX 57, MONTELLO, WI 53949-9049
(608) 297-2085
(608) 297-2426
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
1560
WI
Other
Enumeration date
01/30/2009
Last updated
01/30/2009
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