OrganizationActive
Innovative Services, Inc.
NPI 1437433562 · Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility · Green Bay, WI
Provider details
- NPI number
- 1437433562
- Entity type
- Organization
- Primary specialty
- Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityResidential Treatment Facilities
- Organization subpart
- No
- Authorized official
- Kerry Blondheim, Vice President of Administration(920) 431-0962
Specialties & taxonomies
- Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityPrimary320900000X
Residential Treatment Facilities
Practice location
445 S Madison St
Green Bay, WI 54301-4126
Phone: (920) 431-0962
Fax: (920) 884-1967
Approximate (ZIP-level) locationGet directions
Mailing address
2321 San Luis Pl
Green Bay, WI 54304-5211
Registry dates
- Enumerated
- 2011-10-07
- Last updated
- 2023-02-06
- Certified
- 2023-02-06
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.