Provider Demographics
NPI:1821326455
Name:WHITES RESIDENTIAL TREATMENT & CLINICAL SERVICES, INC.
Entity Type:Organization
Organization Name:WHITES RESIDENTIAL TREATMENT & CLINICAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LANELL
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:CCS
Authorized Official - Phone:414-536-7098
Mailing Address - Street 1:6400 W CAPITOL DR
Mailing Address - Street 2:SUITE 212
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53216-2156
Mailing Address - Country:US
Mailing Address - Phone:414-536-7098
Mailing Address - Fax:414-536-7106
Practice Address - Street 1:4020 W BURLEIGH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53210-1817
Practice Address - Country:US
Practice Address - Phone:414-445-7288
Practice Address - Fax:414-445-7708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-19
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2665324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility