MEDICARE: UNITED COMMUNITY CENTER

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	324500000X	Substance Abuse Rehabilitation Facility	1657	WI
2	324500000X	Substance Abuse Rehabilitation Facility	1949	WI

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1467609776
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNITED COMMUNITY CENTER

Provider Business Mailing Address
First Line	:	1111 S 6TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53204-2301
Country	:	US
Telephone Number	:	414-643-8530
Fax Number	:	414-647-8602

Provider Business Practice Location Address
First Line	:	1111 S 6TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53204-2301
Country	:	US
Telephone Number	:	414-643-8530
Fax Number	:	414-647-8602

Authorized Official
Title or Position	:	DIRECTOR OF HUMAN SERVICES
Name	:	MRS. CINDY KAY SUSZEK
Credential	:	MS SAP CTS CEAP
Telephone Number	:	414-649-1922

Provider Enumeration Date	:	08/19/2008
Last Update Date	:	08/19/2008

7500 SECURITY BOULEVARD , CENTERS FOR MEDICARE & MEDICAID SERVICES
BALTIMORE, MD
21201-2301

Practice Phone: 410-786-6614
Practice Fax: