Provider Demographics
NPI:1093913709
Name:BROADSTEP-WISCONSIN, INC.
Entity Type:Organization
Organization Name:BROADSTEP-WISCONSIN, INC.
Other - Org Name:OKLAHOMA GROUP HOME
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:JULIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:YOPPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-930-4421
Mailing Address - Street 1:5551 N. 51ST BLVD.
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53128
Mailing Address - Country:US
Mailing Address - Phone:414-527-6970
Mailing Address - Fax:414-527-6971
Practice Address - Street 1:3245 S 24TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215-4414
Practice Address - Country:US
Practice Address - Phone:414-671-6965
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-03
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1006139322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children