NPIMap

Organization Active NPI

Exodus Transitional Care Facility Inc.

  • Substance Abuse Rehabilitation Facility
  • Kewaskum, WI
National Provider Identifier
1710304878
Registry record updated Mar 12, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X
License
2598 Issued in WI
Legal business name
EXODUS TRANSITIONAL CARE FACILITY INC.
Practice address
1421 Fond Du Lac Ave
Kewaskum, WI 53040-9136
Phone
(626) 626-4166
Fax
(262) 626-8431
NPI assigned
Mar 26, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 12, 2021

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

Authorized official

Name
Mrs. Cheryl E ColwinNPI 1619219532
Title
Clinical Supervisor/Director
Phone
(262) 626-4166

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Abuse Rehabilitation Facility 324500000X 2598 WI Primary

Addresses

Primary practice location

1421 Fond Du Lac Ave
Kewaskum, WI 53040-9136

Mailing address

1421 Fond Du Lac Ave
Kewaskum, WI 53040-9136
Phone (262) 626-4166

National Provider Directory

National Provider Directory

Locations

1421 Fond du Lac Ave
Kewaskum, WI 53040
Phone (262) 626-4166

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1395792000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1615507200000",
    "number": "1710304878",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1421 FOND DU LAC AVE",
            "city": "KEWASKUM",
            "state": "WI",
            "postal_code": "530409136",
            "telephone_number": "262-626-4166",
            "fax_number": "262-626-8431"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1421 FOND DU LAC AVE",
            "city": "KEWASKUM",
            "state": "WI",
            "postal_code": "530409136",
            "telephone_number": "626-626-4166",
            "fax_number": "262-626-8431"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXODUS TRANSITIONAL CARE FACILITY INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-26",
        "last_updated": "2021-03-12",
        "certification_date": "2021-03-12",
        "status": "A",
        "authorized_official_last_name": "COLWIN",
        "authorized_official_first_name": "CHERYL",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "CLINICAL SUPERVISOR/DIRECTOR",
        "authorized_official_telephone_number": "262-626-4166",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "WI",
            "license": "2598",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kewaskum, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 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.