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NPI 1790067890 · Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility · Green Bay, WI
Provider details
- NPI number
- 1790067890
- Entity type
- Organization
- Primary specialty
- Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityResidential Treatment Facilities
- Organization subpart
- No
- Authorized official
- Marsha Burklund, Controller(920) 431-0962
- License
- 320900000X (WI)
Specialties & taxonomies
- Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityPrimary320900000XLicense 320900000X (WI)
Residential Treatment Facilities
Profile Score
Detailed profile(81/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
14 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
445 S Madison St
Green Bay, WI 54301-4126
Phone: (920) 431-0962
Fax: (920) 884-1967
Street-level locationGet directions
Mailing address
445 S Madison St
Green Bay, WI 54301-4126
Registry dates
- Enumerated
- 2011-09-14
- Last updated
- 2011-09-14
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.