NPIMap

Organization Active NPI

Waukesha County

  • Mental Illness Community Based Residential Treatment Facility
  • Waukesha, WI
National Provider Identifier
1477314854
Registry record updated Nov 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X
Legal business name
WAUKESHA COUNTY
Practice address
1501 Airport Rd
Waukesha, WI 53188-2461
Phone
(262) 548-7950
Fax
(262) 970-6696
NPI assigned
Jan 22, 2024
Last updated
Nov 10, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 10, 2025

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

Authorized official

Name
David M Derosier
Title
Credentialing Specialist
Phone
(262) 548-8431

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Illness Community Based Residential Treatment Facility 320800000X NU Primary
Community/Behavioral Health Agency 251S00000X NU

Addresses

Primary practice location

1501 Airport Rd
Waukesha, WI 53188-2461

Mailing address

514 Riverview Ave
Waukesha, WI 53188-3631
Phone (262) 548-7666

Other identifiers 1

IdentifierTypeStateIssuer
0019880OtherWILICENSE NUMBER

Other names 1

  • Waukesha Co Regional Crisis Stabilization Facility Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040124000130 WI Part B Supplier - Clinic/Group Practice 3971405481 Receives reassigned benefits from 77 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Waukesha, WI

Other NPIs on the same Medicare enrollment 8

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Waukesha County HLTH de13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

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

Locations

500 Riverview Ave
Waukesha, WI 53188
Phone (262) 548-7666

615 W Moreland Blvd
Waukesha, WI 53188
Phone (262) 896-8430

Practitioners & affiliated clinicians

Practitioners 93

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 93

NPI Registry JSON

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

{
    "created_epoch": "1705881600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1762732800000",
    "number": "1477314854",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "514 RIVERVIEW AVE",
            "city": "WAUKESHA",
            "state": "WI",
            "postal_code": "531883631",
            "telephone_number": "262-548-7666",
            "fax_number": "262-970-6696"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1501 AIRPORT RD",
            "city": "WAUKESHA",
            "state": "WI",
            "postal_code": "531882461",
            "telephone_number": "262-548-7950",
            "fax_number": "262-970-6696"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAUKESHA COUNTY",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-01-22",
        "last_updated": "2025-11-10",
        "certification_date": "2025-11-10",
        "status": "A",
        "authorized_official_last_name": "DEROSIER",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "262-548-8431"
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE NUMBER",
            "identifier": "0019880",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Waukesha Co Regional Crisis Stabilization Facility",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Waukesha Co Regional Crisis Stabilization Facility",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Waukesha, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.