Healthcare Provider Details

I. General information

NPI: 1265172795
Provider Name (Legal Business Name): FAMILIES OF HOPE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2022
Last Update Date: 03/31/2022
Certification Date: 03/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6574 N SIDNEY PL APT 103
GLENDALE WI
53209-3232
US

IV. Provider business mailing address

6574 N SIDNEY PL APT 103
GLENDALE WI
53209-3232
US

V. Phone/Fax

Practice location:
  • Phone: 414-731-6097
  • Fax:
Mailing address:
  • Phone: 414-731-6097
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: JASMINE DANIELLE KELLY
Title or Position: DIRECTOR
Credential:
Phone: 414-731-6097