Erc Wisconsin, LLC
Clinic/Center, Adult Mental Health in Wauwatosa, WI. Organization (NPI-2).
NPI number1730853870
StatusActive
Last updated in NPPESFeb 3, 2022
Details
- NPI
- 1730853870
- Entity type
- Organization (NPI-2)
- Legal business name
- Erc Wisconsin, LLC
- Organization subpart
- No
- Enumeration date
- Aug 3, 2021
- Certification date
- Feb 3, 2022
- Last updated
- Feb 3, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QM0850X | Clinic/Center, Adult Mental Health | – | – | Yes |
| 261QM0855X | Clinic/Center, Adolescent and Children Mental Health | – | – | |
| 283Q00000X | Psychiatric Hospital | – | – |
Practice location
2500 N Mayfair Rd Ste 600Wauwatosa, WI 53226-1428
Phone 414-727-4455
Mailing address
7351 E Lowry Blvd Suite #200Denver, CO 80256-1428
Phone 414-727-4455
Authorized official
Marina Shepel
Contracting & Credentialing Manager
4252149321
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