Provider Demographics
NPI:1710560610
Name:BROADSTEP-WISCONSIN, INC.
Entity Type:Organization
Organization Name:BROADSTEP-WISCONSIN, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:JULIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:YOPPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-930-4421
Mailing Address - Street 1:5555 N 51ST ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53218-3308
Mailing Address - Country:US
Mailing Address - Phone:414-527-6970
Mailing Address - Fax:414-527-6971
Practice Address - Street 1:219 LAWRENCE ST
Practice Address - Street 2:
Practice Address - City:FREDONIA
Practice Address - State:WI
Practice Address - Zip Code:53021-9433
Practice Address - Country:US
Practice Address - Phone:262-692-2817
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-29
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility