Wisconsin Recovery Institute

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

Legal business name

WISCONSIN RECOVERY INSTITUTE

Practice address

1446 Lynn Ave
Fond Du Lac, WI 54937-6900

Phone

(920) 990-2104

NPI assigned

Apr 23, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jacob Edelstein

Title

Owner

Phone

(949) 245-8625

Specialties & licenses 3

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1713830400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1713830400000",
    "number": "1053166942",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1446 LYNN AVE",
            "city": "FOND DU LAC",
            "state": "WI",
            "postal_code": "549376900",
            "telephone_number": "920-990-2104"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1446 LYNN AVE",
            "city": "FOND DU LAC",
            "state": "WI",
            "postal_code": "549376900",
            "telephone_number": "920-990-2104"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WISCONSIN RECOVERY INSTITUTE",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-04-23",
        "last_updated": "2024-04-23",
        "certification_date": "2024-04-23",
        "status": "A",
        "authorized_official_last_name": "EDELSTEIN",
        "authorized_official_first_name": "JACOB",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "949-245-8625"
    },
    "taxonomies": [
        {
            "code": "276400000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation, Substance Use Disorder Unit",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "323P00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Residential Treatment Facility",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Nicole Marie Witek, MSW
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• Cynthia Nicole Wittwer, PA-C

• Substance Abuse Rehabilitation Facility in Fond Du Lac, WI
• Providers in Fond Du Lac, WI by specialty
• Substance Abuse Rehabilitation Facility in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2024; 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.