| Organization Name: | TELLURIAN UCAN, INC. LA CROSSE CARE CENTER |
| NPI Number: | 1437401338 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | SARAH LIM (CONTRACT MANAGER) |
| Mailing Address: | 4647 Mormon Coulee Rd La Crosse |
| State: | WI US |
| Postal Code: | 546018225 |
| Phone Number: | 6085193080 |
| Fax Number: | 6085193083 |
| NPI Enumeration Date: | 10/03/2012 |
| NPI Last Update Date: | 10/03/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 320800000X |
| License Number: | 0013220 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WI |
| Taxonomy Type: | Residential Treatment Facilities |
| Taxonomy Classification: | Community Based Residential Treatment Facility, Mental Illness |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness. |