Healthcare Provider Details

I. General information

NPI: 1477467108
Provider Name (Legal Business Name): FAITH BASED DISABILITY RESOURCE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 W WASHINGTON AVE STE 301
MADISON WI
53703-3007
US

IV. Provider business mailing address

PO BOX 210212
MILWAUKEE WI
53221-8004
US

V. Phone/Fax

Practice location:
  • Phone: 414-745-3845
  • Fax: 414-214-7345
Mailing address:
  • Phone: 414-745-3845
  • Fax: 414-214-7345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MS. JANET LEWIS
Title or Position: PRESIDENT
Credential:
Phone: 414-745-3845