Healthcare Provider Details

I. General information

NPI: 1760795322
Provider Name (Legal Business Name): LOVE AND CARE COMMUNITY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2010
Last Update Date: 01/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2266 N PROSPECT AVE SUITE 514
MILWAUKEE WI
53202-6319
US

IV. Provider business mailing address

5609 W THURSTON AVE UNIT B
MILWAUKEE WI
53218-2433
US

V. Phone/Fax

Practice location:
  • Phone: 414-722-3274
  • Fax:
Mailing address:
  • Phone: 414-399-7342
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3700-125
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number7475-123
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number StateWI
# 4
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number120939
License Number StateWI
# 7
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number State

VIII. Authorized Official

Name: MISS LE'KEYA LEE
Title or Position: PROGRAM DIRECTOR
Credential: MMHC
Phone: 414-399-7342