Provider Demographics
NPI:1861546228
Name:BELOTI TREATMENT CENTER
Entity type:Organization
Organization Name:BELOTI TREATMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ERNESTO
Authorized Official - Middle Name:L
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:608-313-0524
Mailing Address - Street 1:1517 E HUEBBE PKWY
Mailing Address - Street 2:STE E
Mailing Address - City:BELOIT
Mailing Address - State:WI
Mailing Address - Zip Code:53511-1795
Mailing Address - Country:US
Mailing Address - Phone:608-313-0524
Mailing Address - Fax:608-313-0887
Practice Address - Street 1:1517 E HUEBBE PKWY
Practice Address - Street 2:STE E
Practice Address - City:BELOIT
Practice Address - State:WI
Practice Address - Zip Code:53511-1795
Practice Address - Country:US
Practice Address - Phone:608-313-0524
Practice Address - Fax:608-313-0887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2689261QM2800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone