PREMIER CARE OF WISCONSIN, LLC.

Clinic/Center — Mental Health (Including Community Mental Health Center)

Code: 261QM0801X

Clinic/Center — Rehabilitation, Substance Use Disorder

Code: 261QR0405X

Counselor — Addiction (Substance Use Disorder)

Code: 101YA0400X

Community/Behavioral Health

Code: 251S00000X

Clinic/Center — Methadone

Code: 261QM2800X