Healthcare Provider Details

I. General information

NPI: 1487549242
Provider Name (Legal Business Name): FEEDING AMERICA EASTERN WI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2025
Last Update Date: 06/11/2025
Certification Date: 06/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 W FOND DU LAC AVE
MILWAUKEE WI
53205-1261
US

IV. Provider business mailing address

1700 W FOND DU LAC AVE
MILWAUKEE WI
53205-1261
US

V. Phone/Fax

Practice location:
  • Phone: 414-931-7400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code335G00000X
TaxonomyMedical Foods Supplier
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE FORD
Title or Position: DIRECTOR OF HEALTH SYSTEM
Credential:
Phone: 414-831-6341