Provider Demographics
NPI:1407160831
Name:SOCIAL REHABILITATION AND RESIDENTIAL RESOURCES, INC.
Entity Type:Organization
Organization Name:SOCIAL REHABILITATION AND RESIDENTIAL RESOURCES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CLINICAL OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:JODY
Authorized Official - Middle Name:
Authorized Official - Last Name:HALFON
Authorized Official - Suffix:
Authorized Official - Credentials:APSW, MSW, CSAC, ICS
Authorized Official - Phone:414-546-6880
Mailing Address - Street 1:10201 W LINCOLN AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53227-2136
Mailing Address - Country:US
Mailing Address - Phone:414-546-6880
Mailing Address - Fax:414-546-6234
Practice Address - Street 1:2187 S 85TH ST
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53227-1747
Practice Address - Country:US
Practice Address - Phone:414-321-2648
Practice Address - Fax:414-321-2676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-27
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15542131324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility