Provider Demographics
NPI:1760525091
Name:BROTOLOC HEALTH CARE SYSTEMS, INC
Entity Type:Organization
Organization Name:BROTOLOC HEALTH CARE SYSTEMS, INC
Other - Org Name:BROTOLOC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:BREED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-832-5085
Mailing Address - Street 1:2710 N TOWN HALL RD
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54703-9687
Mailing Address - Country:US
Mailing Address - Phone:715-874-5050
Mailing Address - Fax:
Practice Address - Street 1:2710 N TOWN HALL RD
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54703-9687
Practice Address - Country:US
Practice Address - Phone:715-874-5050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1907261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42180500Medicaid
WI44340Medicare ID - Type UnspecifiedMEDICARE NUMBER