Provider Demographics
NPI:1235304056
Name:NORRIS ADOLESCENT CENTER
Entity Type:Organization
Organization Name:NORRIS ADOLESCENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:STEWART
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:1262-662-5900
Mailing Address - Street 1:W247S10395 CENTER DR
Mailing Address - Street 2:
Mailing Address - City:MUKWONAGO
Mailing Address - State:WI
Mailing Address - Zip Code:53149-9166
Mailing Address - Country:US
Mailing Address - Phone:262-662-5900
Mailing Address - Fax:262-662-5688
Practice Address - Street 1:W247S10395 CENTER DR
Practice Address - Street 2:
Practice Address - City:MUKWONAGO
Practice Address - State:WI
Practice Address - Zip Code:53149-9166
Practice Address - Country:US
Practice Address - Phone:262-662-5900
Practice Address - Fax:262-662-5688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-23
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI265004322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children