Provider Demographics
NPI:1013261486
Name:TELLURIAN, INC.
Entity Type:Organization
Organization Name:TELLURIAN, INC.
Other - Org Name:TELLURIAN DETOXIFICATION CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:QA MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:
Authorized Official - Last Name:MUELLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-204-8547
Mailing Address - Street 1:5900 MONONA DR STE 300
Mailing Address - Street 2:
Mailing Address - City:MONONA
Mailing Address - State:WI
Mailing Address - Zip Code:53716-3561
Mailing Address - Country:US
Mailing Address - Phone:608-204-8547
Mailing Address - Fax:608-223-3304
Practice Address - Street 1:2914 INDUSTRIAL DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53713-4047
Practice Address - Country:US
Practice Address - Phone:608-223-3311
Practice Address - Fax:608-223-3304
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TELLURIAN, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-11-06
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1904324500000X
324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility