Advocates for Healthy Transitional Living, LLC

Primary specialty

Foster Care AgencyTaxonomy code 253J00000X

License

8038182 Issued in WI

Legal business name

ADVOCATES FOR HEALTHY TRANSITIONAL LIVING, LLC

Practice address

3021 Holmgren Way
Suite 203
Green Bay, WI 54304-6302

Phone

(920) 634-6162

Fax

(920) 339-9374

NPI assigned

Dec 7, 2011

Organization subpart

No

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

Authorized official

Name

Mr. Daniel Robert Holstead, LCSW

Title

Director

Phone

(920) 634-6162

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Foster Care Academy Other name

Locations

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

{
    "created_epoch": "1323216000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1323216000000",
    "number": "1285902015",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3021 HOLMGREN WAY",
            "address_2": "SUITE 203",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543046302",
            "telephone_number": "920-634-6162",
            "fax_number": "920-339-9374"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3021 HOLMGREN WAY",
            "address_2": "SUITE 203",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543046302",
            "telephone_number": "920-634-6162",
            "fax_number": "920-339-9374"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVOCATES FOR HEALTHY TRANSITIONAL LIVING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-07",
        "last_updated": "2011-12-07",
        "status": "A",
        "authorized_official_last_name": "HOLSTEAD",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "ROBERT",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "920-634-6162",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "253J00000X",
            "taxonomy_group": "",
            "desc": "Foster Care Agency",
            "state": "WI",
            "license": "8038182",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "39761600",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Foster Care Academy",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2011; 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.