Provider Demographics
NPI:1346382496
Name:ADOPTION RESOURCES OF WISCONSIN
Entity Type:Organization
Organization Name:ADOPTION RESOURCES OF WISCONSIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:ELLINGSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-475-1246
Mailing Address - Street 1:6682 W GREENFIELD AVE
Mailing Address - Street 2:SUITE 310
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53214
Mailing Address - Country:US
Mailing Address - Phone:414-475-1246
Mailing Address - Fax:414-475-7007
Practice Address - Street 1:6682 W GREENFIELD AVE
Practice Address - Street 2:SUITE 310
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53214-4960
Practice Address - Country:US
Practice Address - Phone:414-475-1246
Practice Address - Fax:414-475-7007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2541251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42237500Medicaid