Provider Demographics
NPI:1275931297
Name:DRYHOOTCH OF AMERICA
Entity Type:Organization
Organization Name:DRYHOOTCH OF AMERICA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIR.OF COMMUNITY PROGRAMS
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:FLOWER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-416-7651
Mailing Address - Street 1:1030 E BRADY ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-1515
Mailing Address - Country:US
Mailing Address - Phone:414-416-7651
Mailing Address - Fax:
Practice Address - Street 1:1030 E BRADY ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-1515
Practice Address - Country:US
Practice Address - Phone:414-416-7651
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-08
Last Update Date:2014-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health