NPIMap

Organization Active NPI

Broadstep-Wisconsin, Inc.

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • Watertown, WI
National Provider Identifier
1003482027
Registry record updated Jun 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X
Legal business name
BROADSTEP-WISCONSIN, INC.
Practice address
503 Clovercrest CT
Watertown, WI 53094-9701
Phone
(920) 390-4431
Fax
(920) 390-4432
NPI assigned
Jun 1, 2021
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Julianne Yopps
Title
Executive Assistant
Phone
(414) 930-4421

Corporate family (same tax ID) 12

Organizations that report the same tax identification number in the National Provider Directory.

National Provider Directory

National Provider Directory
Tax ID family
Bell Therapy - Sheridan Group Home (58 organizations share this tax ID)

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility 320900000X Primary

Addresses

NPPES NPI Registry

Primary practice location

503 Clovercrest CT
Watertown, WI 53094-9701

Mailing address

1205 S 70TH St Ste 202
Milwaukee, WI 53214-3167
Phone (414) 930-4421

Other names 1

NPPES NPI Registry
  • Clovercrest Other name

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jun 1, 2021.

{
    "created_epoch": "1622505600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1622505600000",
    "number": "1003482027",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1205 S 70TH ST STE 202",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532143167",
            "telephone_number": "414-930-4421"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "503 CLOVERCREST CT",
            "city": "WATERTOWN",
            "state": "WI",
            "postal_code": "530949701",
            "telephone_number": "920-390-4431",
            "fax_number": "920-390-4432"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROADSTEP-WISCONSIN, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-01",
        "last_updated": "2021-06-01",
        "certification_date": "2021-06-01",
        "status": "A",
        "authorized_official_last_name": "YOPPS",
        "authorized_official_first_name": "JULIANNE",
        "authorized_official_title_or_position": "EXECUTIVE ASSISTANT",
        "authorized_official_telephone_number": "414-930-4421"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Clovercrest",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Watertown, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.