Organization · NPI-2

4th Dimension Recovery Centers

Clinic/Center, Rehabilitation, Substance Use Disorder · Milwaukee, WI

NPI number1538634829
StatusActive
Last updated in NPPESOct 10, 2024

Details

NPI
1538634829
Entity type
Organization (NPI-2)
Legal business name
4th Dimension Recovery Centers
Organization subpart
No
Enumeration date
Oct 12, 2018
Certification date
Oct 10, 2024
Last updated
Oct 10, 2024

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder––Yes
261QM0850X Clinic/Center, Adult Mental Health––

Practice location

1216 N Prospect Ave
Milwaukee, WI 53202-3061

Phone 973-277-5359 · Fax 928-441-1686

Mailing address

1216 N Prospect Ave
Milwaukee, WI 53202-3061

Phone 973-277-5359

Other practice locations

1216 N Prospect Ave
Milwaukee, WI 53202-3061

Phone 973-277-5359

Authorized official

Jason Lee Luell
Chief Operations Officer
4144067852

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