Provider Demographics
NPI:1013572353
Name:ADDICTION SERVICES AND PHARMACOTHERAPY, SC
Entity Type:Organization
Organization Name:ADDICTION SERVICES AND PHARMACOTHERAPY, SC
Other - Org Name:NEW ADDICTION SERVICES AND PHARMACOTHERAPY WEST ALLIS
Other - Org Type:Other Name
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:P
Authorized Official - Last Name:HARKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:608-279-6879
Mailing Address - Street 1:11390 W THEODORE TRECKER WAY
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53214-1135
Mailing Address - Country:US
Mailing Address - Phone:414-928-1401
Mailing Address - Fax:
Practice Address - Street 1:11390 W THEODORE TRECKER WAY
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53214-1135
Practice Address - Country:US
Practice Address - Phone:414-928-1401
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADDICTION SERVICES AND PHARMACOTHERAPY, SC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-05-02
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone