Provider Demographics
NPI:1831464536
Name:ALCOCARE INC.
Entity Type:Organization
Organization Name:ALCOCARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:SHANE
Authorized Official - Last Name:BOLAN
Authorized Official - Suffix:
Authorized Official - Credentials:CAPSW
Authorized Official - Phone:608-751-1042
Mailing Address - Street 1:786 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53545-4852
Mailing Address - Country:US
Mailing Address - Phone:608-754-6800
Mailing Address - Fax:608-754-2651
Practice Address - Street 1:786 S MAIN ST
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53545-4852
Practice Address - Country:US
Practice Address - Phone:608-754-6800
Practice Address - Fax:608-754-2651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-13
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1023324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility