Provider Demographics
NPI:1790972461
Name:AJA CHILD & ADOLESCENT DAY TREATMENT
Entity Type:Organization
Organization Name:AJA CHILD & ADOLESCENT DAY TREATMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:AREATHA
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:414-353-9250
Mailing Address - Street 1:8726 W MILL RD
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53225-1838
Mailing Address - Country:US
Mailing Address - Phone:414-353-9250
Mailing Address - Fax:414-353-2095
Practice Address - Street 1:8726 W MILL RD
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53225-1838
Practice Address - Country:US
Practice Address - Phone:414-353-9250
Practice Address - Fax:414-353-2095
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AJA ENTERPRISES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-09-26
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1205251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43008300Medicaid