Healthcare Provider Details

I. General information

NPI: 1063766806
Provider Name (Legal Business Name): URBAN NORTH NEIGHBORHOOD CONCERNS ASSOCIATION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2012
Last Update Date: 11/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2821 N 4TH ST RM 208
MILWAUKEE WI
53212-2362
US

IV. Provider business mailing address

5930 N 75TH ST
MILWAUKEE WI
53218-1834
US

V. Phone/Fax

Practice location:
  • Phone: 888-273-6691
  • Fax: 888-273-6691
Mailing address:
  • Phone: 888-273-6691
  • Fax: 888-273-6691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: TIFFANY LITTLE
Title or Position: DIRECTOR
Credential:
Phone: 18882736691