Basic Information
| Provider Information | |||||||||
| NPI: | 1346718806 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BEAUTERRE RECOVERY INSTITUTE WISCONSIN LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 550 MAIN ST STE 190 | ||||||||
| Address2: | |||||||||
| City: | NEW BRIGHTON | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551123271 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6124542046 | ||||||||
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| Practice Location | |||||||||
| Address1: | 321 RIVERSIDE DR | ||||||||
| Address2: | |||||||||
| City: | PEWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 530724612 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6124542046 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/02/2018 | ||||||||
| LastUpdateDate: | 11/02/2018 | ||||||||
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| AuthorizedOfficialLastName: | ASPER | ||||||||
| AuthorizedOfficialFirstName: | LISA | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR CONTRACTING | ||||||||
| AuthorizedOfficialTelephone: | 6124542046 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 324500000X | Y | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility |
No ID Information.