Provider Demographics
NPI:1558609750
Name:CLINICARE CORPORATION - MILWAUKEE ACADEMY
Entity Type:Organization
Organization Name:CLINICARE CORPORATION - MILWAUKEE ACADEMY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:EVA
Authorized Official - Middle Name:THERESE
Authorized Official - Last Name:CRIBBEN
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:414-257-3141
Mailing Address - Street 1:10201 W LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53227-2136
Mailing Address - Country:US
Mailing Address - Phone:414-257-3141
Mailing Address - Fax:414-257-3151
Practice Address - Street 1:9501 W WATERTOWN PLANK RD
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-3552
Practice Address - Country:US
Practice Address - Phone:414-257-3141
Practice Address - Fax:414-257-3151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-22
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1178-226320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness