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LAKESHORES OUTPATIENT CLINIC NPI 1629111943


NPI Information

NPI: 1629111943
Provider Name: LAKESHORES OUTPATIENT CLINIC

Doing Business As: BROTOLOC

Classification: Clinic/Center - 261QM0801X
Entity Type: Organization

Specialization: Mental Health (Including Community Mental Health Center)

Address:
3917 47TH AVE
KENOSHA, WI
ZIP 53144
Phone: (262) 656-9975
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LAKESHORES OUTPATIENT CLINIC is a mental health (including community mental health center) clinic center in Kenosha, WI. LAKESHORES OUTPATIENT CLINIC NPI is 1629111943. The provider is registered as an organization entity type.
The provider Is Doing Business As Brotoloc.

The provider's business location address is:

3917 47TH AVE
KENOSHA, WI
ZIP 53144-956
Phone: (262) 656-9975
Fax: (262) 656-9974

The provider's authorized official is Melanie Barbeaux-stinson .
The authorized official title is Director and has the following contact phone number (262) 656-9975.

The enumeration date for this NPI number is 2/15/2007 and was last updated on 8/22/2020.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1261QM0801XClinic/CenterMental Health (Including Community Mental Health Center)2605WISCONSINYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
142242400MEDICAIDWISCONSIN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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