PROFESSIONAL RECOVERY NETWORK (NPI# 1811104995) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1811104995 |
| Entity Type | Organization |
| Organization Name | PROFESSIONAL RECOVERY NETWORK |
| Practice Address |
2422 North Grandview Blvd Waukesha WI 53188 |
| Practice Telephone | 2625496600 |
| Practice Fax Number | 2625496698 |
| Mailing Telephone | 2625496600 |
| Mailing Fax Number | 2625496698 |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | CHARLES JOHN ENGEL (PRESIDENT) |
| Authorized Official Telephone | 2625496600 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 324500000X | Substance Abuse Rehabilitation Facility | 1747 | WI | Residential Treatment Facilities |
| Y | 324500000X | Substance Abuse Rehabilitation Facility | 1748 | WI | Residential Treatment Facilities |
| Street Address |
2422 NORTH GRANDVIEW BLVD |
| City | WAUKESHA |
| State | WI |
| Zip Code | 53188 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063529675 | Julie Ann Burtness | Counselor | 2422 North Grandview Blvd, Waukesha, WI 53188 | 2006-08-23 |
| 1447449319 | Barbara J Kuechler | Registered Nurse | 2422 North Grandview Blvd, Waukesha, WI 53188 | 2007-10-17 |
| 1598970170 | James Marcel Campeaux | Counselor | 2422 North Grandview Blvd, Waukesha, WI 53188 | 2007-05-14 |
| 1578777249 | Kay L Strauss | Counselor | 2422 North Grandview Blvd, Waukesha, WI 53188 | 2007-05-10 |
| 1861606535 | Dave Lyons | Counselor | 2422 North Grandview Blvd, Waukesha, WI 53188 | 2007-05-10 |
| 1871707422 | Elizabeth Ann Gilbert | Registered Nurse | 2422 North Grandview Blvd, Waukesha, WI 53188 | 2007-05-10 |
| 1831303577 | Kathleen J Maloney | Registered Nurse | 2422 North Grandview Blvd, Waukesha, WI 53188 | 2007-05-10 |
| 1851505416 | Michael S Goldstone | Internal Medicine | 2422 North Grandview Blvd, Waukesha, WI 53188 | 2007-05-10 |
| 1649484205 | Charles J Engel | Internal Medicine | 2422 North Grandview Blvd, Waukesha, WI 53188 | 2007-05-10 |
| 1902010671 | Gale F Mortl | Licensed Practical Nurse | 2422 North Grandview Blvd, Waukesha, WI 53188 | 2007-05-10 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336787126 | Nicole Lee Berg-johnson | Nurse Practitioner | 820 Crestwood Dr., Waukesha, WI 53188 | 2019-12-12 |
| 1013475706 | Rachel Mueller | Occupational Therapist | 29667 Summit Ave, S11, Waukesha, WI 53188 | 2019-03-12 |
| 1861962649 | Emily Elizabeth Seefeld | Occupational Therapy Assistant | 29667 Summit Ave S11, Waukesha, WI 53188 | 2018-12-05 |
| 1003393307 | Ashley Susan Callahan | Dental Hygienist | 711 W. Moreland Blvd., Suite 204, Waukesha, WI 53188 | 2018-07-19 |
| 1245741321 | Melissa Weir | Case Manager/Care Coordinator | 514 Riverview Avenue, Waukesha, WI 53188 | 2017-10-17 |
| 1093233629 | Patricia Marie Sombrio | Dental Hygienist | 711 Moreland Blvd 204, Waukesha, WI 53188 | 2017-09-04 |
| 1134660244 | Bdg of Wisconsin, Inc. | Behavioral Analyst | N19w2309 Riverwood Drive, Suite 350 Pmb 314, Waukesha, WI 53188 | 2017-03-09 |
| 1255888731 | Lynne Sarah Alva | Dental Hygienist | 711 Moreland Blvd, Suite 204, Waukesha, WI 53188 | 2016-09-01 |
| 1881069730 | Michelle Koch | Occupational Therapist | 29667 Summit Ave. S11, Waukesha, WI 53188 | 2015-12-03 |
| 1952711012 | Rhonda Schroeder | Dental Hygienist | W286 N991 Shepherds Way, Waukesha, WI 53188 | 2014-04-29 |
| Find all providers in zip 53188 | ||||
| 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 |
|---|---|---|---|---|
| 1437224961 | Lutheran Social Services of Wisconsin and Upper Michigan, Inc. | Substance Abuse Rehabilitation Facility | 1002 Motor Ave, Waukesha, WI 53188-4955 | 2006-11-21 |
| 1528133071 | Lutheran Social Services of Wisconsin and Upper Michigan, Inc. | Substance Abuse Rehabilitation Facility | 325 Sentinel Dr, Waukesha, WI 53189-7551 | 2006-11-21 |
| 1851935605 | Lss Aspen Center LLC | Substance Abuse Rehabilitation Facility | 2000 W Bluemound Rd, Waukesha, WI 53186-2787 | 2019-11-05 |
| 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 |
| 1710304878 | Exodus Transitional Care Facility Inc. | Substance Abuse Rehabilitation Facility | 1421 Fond Du Lac Ave, Kewaskum, WI 53040-9136 | 2014-03-26 |
| 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 |
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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.