Provider Demographics
NPI:1871940213
Name:B.A.ISRAEL LLC
Entity type:Organization
Organization Name:B.A.ISRAEL LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:BRIGHT
Authorized Official - Middle Name:
Authorized Official - Last Name:AMUDOAGHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-416-8534
Mailing Address - Street 1:N9520 SILVER COURT
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54915
Mailing Address - Country:US
Mailing Address - Phone:920-832-9290
Mailing Address - Fax:920-832-0327
Practice Address - Street 1:N9520 SILVER COURT
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54915
Practice Address - Country:US
Practice Address - Phone:920-832-9290
Practice Address - Fax:920-832-0327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-16
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI0015847320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness