Provider Demographics
NPI:1356907133
Name:RGN FAMILY BEHAVIORAL HEALTH, LLC
Entity type:Organization
Organization Name:RGN FAMILY BEHAVIORAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATE
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:GUMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-434-0908
Mailing Address - Street 1:6917 W OKLAHOMA AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53219-2973
Mailing Address - Country:US
Mailing Address - Phone:414-545-7425
Mailing Address - Fax:
Practice Address - Street 1:6917 W OKLAHOMA AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53219-2973
Practice Address - Country:US
Practice Address - Phone:414-545-7425
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-16
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty