Provider Demographics
NPI:1104019868
Name:BROADSTEP-WISCONSIN, INC.
Entity Type:Organization
Organization Name:BROADSTEP-WISCONSIN, INC.
Other - Org Name:
Other - Org Type:
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 1:10133 - 35 WEST KIEHNAU AVENUE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53224
Mailing Address - Country:US
Mailing Address - Phone:414-353-5567
Mailing Address - Fax:414-353-4236
Practice Address - Street 1:10133 - 35 WEST KIEHNAU AVENUE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53224
Practice Address - Country:US
Practice Address - Phone:414-353-5567
Practice Address - Fax:414-353-4236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-24
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities