Provider Demographics
NPI:1922140953
Name:CRC HEALTH GROUP INC.
Entity Type:Organization
Organization Name:CRC HEALTH GROUP INC.
Other - Org Name:BELOIT TREAMNET CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CSAC
Authorized Official - Prefix:MR
Authorized Official - First Name:GLEN
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:POFAHL
Authorized Official - Suffix:
Authorized Official - Credentials:11121132
Authorized Official - Phone:608-331-0524
Mailing Address - Street 1:929 SUFFOLK DR
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53546-1821
Mailing Address - Country:US
Mailing Address - Phone:608-756-3546
Mailing Address - Fax:
Practice Address - Street 1:1517 E HUEBBE PKWY
Practice Address - Street 2:
Practice Address - City:BELOIT
Practice Address - State:WI
Practice Address - Zip Code:53511-1795
Practice Address - Country:US
Practice Address - Phone:608-331-0524
Practice Address - Fax:608-313-0887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)