Provider Demographics
NPI:1548302474
Name:CRC HEALTH GROUP INC.
Entity type:Organization
Organization Name:CRC HEALTH GROUP INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CSAC
Authorized Official - Prefix:MR
Authorized Official - First Name:GLEN
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:POFAHL
Authorized Official - Suffix:
Authorized Official - Credentials:11121132
Authorized Official - Phone:608-313-0425
Mailing Address - Street 1:929 SUFFOLK DR
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53546-1821
Mailing Address - Country:US
Mailing Address - Phone:608-756-3546
Mailing Address - Fax:
Practice Address - Street 1:929 SUFFOLK DR
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53546-1821
Practice Address - Country:US
Practice Address - Phone:608-756-3546
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2689261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)