EXODUS TRANSITIONAL CARE FACILITY INC. (NPI# 1710304878) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1710304878 |
| Entity Type | Organization |
| Organization Name | EXODUS TRANSITIONAL CARE FACILITY INC. |
| Practice Address |
1421 Fond Du Lac Ave Kewaskum WI 53040-9136 |
| Practice Telephone | 6266264166 |
| Practice Fax Number | 2626268431 |
| Mailing Telephone | 2626264166 |
| Mailing Fax Number | 2626268431 |
| Enumeration Date | 2014-03-26 |
| Last Update Date | 2014-03-26 |
| Authorized Official Name | CRAIG ALAN BRUESEWITZ (DIRECTOR/ LEAD COUNSELOR) |
| Authorized Official Telephone | 2626264166 |
| Authorized Official Credential | MSE-CSAC-ICS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 324500000X | Substance Abuse Rehabilitation Facility | 2598 | WI | Residential Treatment Facilities |
| Street Address |
1421 FOND DU LAC AVE |
| City | KEWASKUM |
| State | WI |
| Zip Code | 53040-9136 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669962825 | Nicole Shannon Thull | Counselor | 1421 Fond Du Lac Ave, Kewaskum, WI 53040-9136 | 2018-05-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902076698 | Craig Alan Bruesewitz | Counselor | 1421 Fond Du Lac Avenue, Kewashum, WI 53040 | 2008-03-10 |
| 1508040700 | Sara Marie Bonlender | Licensed Practical Nurse | 1841 Edgewood Road, Kewaskum, WI 53040 | 2007-12-24 |
| 1861506255 | Kewaskum Fire Department | Ambulance | 1106 Fond Du Lac Ave, Kewaskum, WI 53040 | 2006-08-19 |
| 1619219532 | Cheryl Elizabeth Colwin | Counselor | 1421 Fond Du Lac Avenue, Kewaskum, WI 53040 | 2013-03-18 |
| 1790188498 | Nicolai Gerhartz | Physician Assistant | W832 County Rd S, Kewaskum, WI 53040-1116 | 2014-10-08 |
| 1871785931 | Kewaskum School District | Speech-Language Pathologist | 1676 Reigle Dr Ste 100, Kewaskum, WI 53040-8923 | 2007-08-13 |
| 1891801957 | J Dennis Connor | Dentist | 1204 Fond Du Lac Ave, Kewaskum, WI 53040-8954 | 2006-08-22 |
| 1003941444 | J Dennis Connor Dds Sc | Dentist | 1204 Fond Du Lac Ave, Kewaskum, WI 53040-8954 | 2007-02-23 |
| 1093241002 | Nicholas Brandon Bier | Student in an Organized Health Care Education/Training Program | 311 Clinton St, Kewaskum, WI 53040-9116 | 2017-05-11 |
| 1518976919 | West Bend Clinic | Internal Medicine | 1701 Fond Du Lac Ave, Kewaskum, WI 53040-9129 | 2006-08-05 |
| Find all providers in zip 53040 | ||||
| Taxonomy Code | 324500000X |
| Grouping | Residential Treatment Facilities |
| Classification | Substance Abuse Rehabilitation Facility |
| A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances. |
| Notes: [7/1/2003: modified title, modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114415908 | Iris Health Clinic LLC | Substance Abuse Rehabilitation Facility | 260 S Elm Grove Rd, Brookfield, WI 53005-6522 | 2018-04-26 |
| 1396259420 | Whole Life Services LLC | Substance Abuse Rehabilitation Facility | 819 Ash St Ste 150, Spooner, WI 54801-1201 | 2017-11-28 |
| 1306298740 | Phoenix Counseling | Substance Abuse Rehabilitation Facility | 64 S 4th St, Barron, WI 54812-1503 | 2016-07-11 |
| 1043684251 | Millenium Manor, LLC | Substance Abuse Rehabilitation Facility | 4509 Arthur Rd, Slinger, WI 53086-9603 | 2015-11-25 |
| 1780081174 | Psthways To A Better Life 1, LLC | Substance Abuse Rehabilitation Facility | 13111 Lax Chapel Rd, Kiel, WI 53042-3954 | 2014-12-01 |
| 1558798686 | Friends of Women In Recovery Inc. | Substance Abuse Rehabilitation Facility | 166 S Park Ave, Fond Du Lac, WI 54935-4441 | 2013-10-03 |
| 1457784662 | The Pines Treatment & Recovery Center | Substance Abuse Rehabilitation Facility | N3387 State Road 73, Wautoma, WI 54982-5257 | 2013-08-12 |
| 1215375472 | Hope Haven | Substance Abuse Rehabilitation Facility | 3602 Memorial Dr, Madison, WI 53704-1106 | 2013-06-10 |
| 1831464536 | Alcocare Inc. | Substance Abuse Rehabilitation Facility | 786 S Main St, Janesville, WI 53545-4852 | 2012-03-13 |
| 1548538275 | Options Counseling Services, LLC | Substance Abuse Rehabilitation Facility | 9433 County Rd J, Minocqua, WI 54548-9318 | 2011-12-08 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.