Organization
BROTOLOC SOUTH, INC.
Active
Parent organization
BROTOLOC SOUTH, INC.
Organization subpart
Yes
Provider details
NPI number
Legal business name
BROTOLOC SOUTH, INC.
Authorized official
DOUG E SVEDA (DIRECTOR)
(414) 543-3200
Entity
Organization
Contact information
Practice address
5812 W BURNHAM ST, WEST ALLIS, WI 53219-1524
(414) 543-3200
(414) 543-3269
Mailing address
5812 W BURNHAM ST, WEST ALLIS, WI 53219-1524
(414) 543-3200
(414) 543-3269
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42207400
—
WI
Enumeration date
12/10/2009
Last updated
04/26/2010
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