Provider Demographics
NPI:1538820790
Name:ADDICTION SERVICES AND PHARMACOTHERAPY, SC
Entity type:Organization
Organization Name:ADDICTION SERVICES AND PHARMACOTHERAPY, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:P
Authorized Official - Last Name:HARKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:262-946-5752
Mailing Address - Street 1:3825 39TH AVE SUITE 120
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53144
Mailing Address - Country:US
Mailing Address - Phone:262-946-5752
Mailing Address - Fax:262-946-5765
Practice Address - Street 1:3825 39TH AVE SUITE 120
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53144
Practice Address - Country:US
Practice Address - Phone:262-946-5752
Practice Address - Fax:262-946-5765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-09
Last Update Date:2022-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone