Provider Demographics
NPI:1356412506
Name:BURKWOOD, INC.
Entity type:Organization
Organization Name:BURKWOOD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:LISETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:BLAISDELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-386-6125
Mailing Address - Street 1:615 OLD MILL RD
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:WI
Mailing Address - Zip Code:54016-6959
Mailing Address - Country:US
Mailing Address - Phone:715-386-6125
Mailing Address - Fax:715-386-8775
Practice Address - Street 1:615 OLD MILL RD
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:WI
Practice Address - Zip Code:54016-6959
Practice Address - Country:US
Practice Address - Phone:715-386-6125
Practice Address - Fax:715-386-8775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility