Healthcare Provider Details

I. General information

NPI: 1235470048
Provider Name (Legal Business Name): LUE'S VISIONS OF SUCCESS AND PROSPERITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2013
Last Update Date: 03/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6452 W MEDFORD AVE
MILWAUKEE WI
53218-4835
US

IV. Provider business mailing address

6452 W MEDFORD AVE
MILWAUKEE WI
53218-4835
US

V. Phone/Fax

Practice location:
  • Phone: 414-405-4022
  • Fax:
Mailing address:
  • Phone: 414-405-4022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: YVONNE PERRY
Title or Position: MANAGER
Credential:
Phone: 414-405-4022