Provider Demographics
NPI:1851969638
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:414-920-4421
Mailing Address - Street 1:1205 S 70TH ST STE 202
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53214-3167
Mailing Address - Country:US
Mailing Address - Phone:414-930-4421
Mailing Address - Fax:
Practice Address - Street 1:208 E HAVEN DR
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:WI
Practice Address - Zip Code:53094-7319
Practice Address - Country:US
Practice Address - Phone:920-206-9363
Practice Address - Fax:920-206-9365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-16
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities