Provider Demographics
NPI:1871334045
Name:GROUP HEALTH COOPERATIVE OF SOUTH CENTRAL WI - AUTISM
Entity type:Organization
Organization Name:GROUP HEALTH COOPERATIVE OF SOUTH CENTRAL WI - AUTISM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:QUADE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-251-4156
Mailing Address - Street 1:1265 JOHN Q HAMMONS DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53717-1921
Mailing Address - Country:US
Mailing Address - Phone:608-251-4156
Mailing Address - Fax:608-662-4984
Practice Address - Street 1:675 W WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53703-2637
Practice Address - Country:US
Practice Address - Phone:608-257-9700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GROUP HEALTH COOPERATIVE OF SOUTH CENTRAL WISCONSIN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)