Provider Demographics
NPI:1669602488
Name:AADVANTAGE BEHAVIORAL HEALTHCARE, LLC
Entity type:Organization
Organization Name:AADVANTAGE BEHAVIORAL HEALTHCARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:GALE
Authorized Official - Last Name:BUSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-843-4555
Mailing Address - Street 1:N6658 WOODFIELD LN
Mailing Address - Street 2:
Mailing Address - City:LAKE MILLS
Mailing Address - State:WI
Mailing Address - Zip Code:53551-9740
Mailing Address - Country:US
Mailing Address - Phone:608-843-4555
Mailing Address - Fax:
Practice Address - Street 1:125 E PINE ST
Practice Address - Street 2:
Practice Address - City:LAKE MILLS
Practice Address - State:WI
Practice Address - Zip Code:53551-1103
Practice Address - Country:US
Practice Address - Phone:608-843-4555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-15
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2498261QM0801X
WI6647-123261QM0850X, 261QM0855X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42236300Medicaid
WI000044670Medicare PIN