Provider Demographics
NPI:1598931248
Name:JUVENILE ASSESSMENT AND TREATMENT CENTER, LLC
Entity Type:Organization
Organization Name:JUVENILE ASSESSMENT AND TREATMENT CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LORRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROLLER
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:608-242-8780
Mailing Address - Street 1:2453 ATWOOD AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53704-5661
Mailing Address - Country:US
Mailing Address - Phone:608-242-8780
Mailing Address - Fax:608-242-8790
Practice Address - Street 1:2453 ATWOOD AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-5661
Practice Address - Country:US
Practice Address - Phone:608-242-8780
Practice Address - Fax:608-242-8790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-02
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2486251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health