RED ROAD HOUSE (NPI# 1023527769) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1023527769 |
| Entity Type | Organization |
| Organization Name | RED ROAD HOUSE |
| Practice Address |
152 S Locust St Janesville WI 53548-3767 |
| Practice Telephone | 6087569252 |
| Mailing Telephone | 6087562592 |
| Mailing Fax Number | 6087562592 |
| Enumeration Date | 2017-09-26 |
| Last Update Date | 2019-06-11 |
| Authorized Official Name | MISS WILLIAM GRAHN (FOUNDER/DIRECTOR) |
| Authorized Official Telephone | 6087562592 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 405300000X | Prevention Professional | WI | Other Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | STATE OF WISCONSIN DEPARTMENT OF HEALTH SERVICES | 0016168 | 01 |
| Street Address |
152 S LOCUST ST |
| City | JANESVILLE |
| State | WI |
| Zip Code | 53548-3767 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578846010 | Patricia Ann Sheets | Licensed Vocational Nurse | 316 N. Terrace St., Janbesville, WI 53548 | 2011-09-21 |
| 1760658983 | Kristy Kay Prentice Kerl | Dental Hygienist | 121 Jonathon Dr, Janesville, WI 53548 | 2008-05-07 |
| 1316005978 | City of Janesville | Emergency Medical Technician, Paramedic | 18 N Jackson St, Janesville, WI 53548 | 2006-12-05 |
| 1558464115 | Sarah Louise Hessenauer | Social Worker | 17 S. River St, Suite 254, Janesville, WI 53548 | 2006-09-07 |
| 1073548327 | Mary Katherine Cefalu | Registered Nurse | 17 S. River, Suite 254, Janesville, WI 53548 | 2006-07-12 |
| 1699707950 | Gary Lavern Jones | Counselor | 175 River, Suite 254, Janesville, WI 53548 | 2006-07-07 |
| 1295767424 | Michael Stuart Kaye | Clinical Neuropsychologist | 17 S River St Ste 254, Janesville, WI 53548 | 2006-07-07 |
| 1205864055 | Amy Laurie Roy | Counselor | 17 S River Suite 254, Janesville, WI 53548 | 2006-06-29 |
| 1518903566 | Leota I Larson | Psychologist | 17 S River, Suite 254, Janesville, WI 53548 | 2006-06-20 |
| 1760950414 | North Star Chiropractic LLC | Chiropractor | 21 S Jackson St, Ste 160, Janesville, WI 53548 | 2018-11-10 |
| Find all providers in zip 53548 | ||||
| Taxonomy Code | 405300000X |
| Grouping | Other Service Providers |
| Classification | Prevention Professional |
| Prevention Professionals work in programs aimed to address specific patient needs, such as suicide prevention, violence prevention, alcohol avoidance, drug avoidance, and tobacco prevention. The goal of the program is to reduce the risk of relapse, injury, or re-injury of the patient. Prevention Professionals work in a variety of settings and provide appropriate case management, mediation, referral, and mentorship services. Individuals complete prevention professionals training for the population of patients with whom they work. |
| Notes: Source: National Uniform Claim Committee, 2015 [1/1/2016: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326679663 | Andrea Maria Dosedla | Prevention Professional | N61w23044 Harrys Way, Sussex, WI 53089-3995 | 2020-01-27 |
| 1063981710 | Jon Maurice Smoots | Prevention Professional | 7710 W. Casper Street, Milwaukee, WI 53216 | 2018-11-23 |
| 1164963187 | Anna Lanman | Prevention Professional | 303 12th Ave, Baraboo, WI 53913-1612 | 2017-03-09 |
| 1407396013 | Douglas Radtke | Prevention Professional | 6233 Bankers Rd, Suite 12, Mount Pleasant, WI 53403-9700 | 2017-03-01 |
| 1659819076 | Haley Jacob | Prevention Professional | 1725 State St, 126 Mitchell Hall, La Crosse, WI 54601-3742 | 2017-02-06 |
| 1043627912 | Sonia Porter | Prevention Professional | 5151 W Silver Spring Dr, Milwaukee, WI 53218-3300 | 2014-07-12 |
| City | JANESVILLE |
| Zip Code | 53548 |
Please comment or provide details below to improve the information on RED ROAD HOUSE.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.