Basic Information
| Provider Information | |||||||||
| NPI: | 1982821930 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AURORA PSYCHIATRIC HOSPITAL, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1220 DEWEY AVE | ||||||||
| Address2: | |||||||||
| City: | WAUWATOSA | ||||||||
| State: | WI | ||||||||
| PostalCode: | 53213 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4144546600 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1220 DEWEY AVE | ||||||||
| Address2: | |||||||||
| City: | WAUWATOSA | ||||||||
| State: | WI | ||||||||
| PostalCode: | 53213 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4144546600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2007 | ||||||||
| LastUpdateDate: | 06/11/2018 | ||||||||
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| AuthorizedOfficialLastName: | NELSON | ||||||||
| AuthorizedOfficialFirstName: | NAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | TREASURER | ||||||||
| AuthorizedOfficialTelephone: | 4142991610 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | 283Q00000X | N | Hospitals | Psychiatric Hospital | 261QM0801X | Y | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
ID Information
| ID | Type | State | Issuer | Description | 42195000 | 05 | WI | MEDICAID | 42195600 | 05 | WI | MEDICAID | 42230600 | 05 | WI | MEDICAID | 42194900 | 05 | WI | MEDICAID | 42229800 | 05 | WI | MEDICAID | 42228800 | 05 | WI | MEDICAID | 42195200 | 05 | WI | MEDICAID | 42228600 | 05 | WI | MEDICAID | 42229900 | 05 | WI | MEDICAID |