Provider Demographics
NPI:1336508613
Name:SALS RECOVERY CENTER LLC
Entity Type:Organization
Organization Name:SALS RECOVERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:T
Authorized Official - Last Name:BRUNZELLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-701-7257
Mailing Address - Street 1:223 WISCONSIN AVE
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53186-4968
Mailing Address - Country:US
Mailing Address - Phone:262-701-7257
Mailing Address - Fax:
Practice Address - Street 1:223 WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53186-4968
Practice Address - Country:US
Practice Address - Phone:971-334-3150
Practice Address - Fax:262-753-6897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-16
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3129251S00000X, 261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty