NPIMap

Organization Active NPI

Iris Health Clinic LLC

  • Substance Abuse Rehabilitation Facility
  • Weyauwega, WI
National Provider Identifier
1588360705
Registry record updated Jan 31, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X
Legal business name
IRIS HEALTH CLINIC LLC
Practice address
N3501 State Road 110
Weyauwega, WI 54983-8644
Phone
(262) 420-9088
Fax
(262) 458-4102
NPI assigned
Jan 31, 2023
Last updated
Jan 31, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 31, 2023

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

Authorized official

Name
Peter Brunzelle
Title
President
Phone
(262) 420-9088

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Abuse Rehabilitation Facility 324500000X NU Primary

Addresses

Primary practice location

N3501 State Road 110
Weyauwega, WI 54983-8644

Mailing address

255 W Broadway
Waukesha, WI 53186-4832
Phone (262) 420-9088

National Provider Directory

National Provider Directory
Tax ID family
Iris Health Clinic5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

NPI Registry JSON

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

{
    "created_epoch": "1675123200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1675123200000",
    "number": "1588360705",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "255 W BROADWAY",
            "city": "WAUKESHA",
            "state": "WI",
            "postal_code": "531864832",
            "telephone_number": "262-420-9088"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "N3501 STATE ROAD 110",
            "city": "WEYAUWEGA",
            "state": "WI",
            "postal_code": "549838644",
            "telephone_number": "262-420-9088",
            "fax_number": "262-458-4102"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IRIS HEALTH CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-01-31",
        "last_updated": "2023-01-31",
        "certification_date": "2023-01-31",
        "status": "A",
        "authorized_official_last_name": "BRUNZELLE",
        "authorized_official_first_name": "PETER",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "262-420-9088"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Weyauwega, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2023; 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.