Provider Demographics
NPI:1407478258
Name:MONARCH ADDICTION RECOVERY CLINICS SC
Entity Type:Organization
Organization Name:MONARCH ADDICTION RECOVERY CLINICS SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHERI
Authorized Official - Middle Name:
Authorized Official - Last Name:RETTEW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-669-5422
Mailing Address - Street 1:521 E WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53703-2900
Mailing Address - Country:US
Mailing Address - Phone:608-729-9388
Mailing Address - Fax:
Practice Address - Street 1:521 E WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53703-2900
Practice Address - Country:US
Practice Address - Phone:608-217-2963
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-15
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1154388213Medicaid
WI1154521425Medicaid