Provider Demographics
NPI:1639240252
Name:ASPEN BREEZE TREATMENT CENTER, INC
Entity Type:Organization
Organization Name:ASPEN BREEZE TREATMENT CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:S
Authorized Official - Last Name:PENHALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:906-228-9699
Mailing Address - Street 1:100 N FRONT ST STE 302
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-4303
Mailing Address - Country:US
Mailing Address - Phone:906-228-9699
Mailing Address - Fax:906-228-0505
Practice Address - Street 1:100 N FRONT ST STE 302
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-4303
Practice Address - Country:US
Practice Address - Phone:906-228-9699
Practice Address - Fax:906-228-0505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health