Healthcare Provider Details

I. General information

NPI: 1730487505
Provider Name (Legal Business Name): SOCIAL DEVELOPMENT COMMISSION-(YFDP)
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2011
Last Update Date: 03/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4041 N RICHARD'S STREET
MILWAUKEE WI
53212
US

IV. Provider business mailing address

4041 N RICHARD'S STREET
MILWAUKEE WI
53212
US

V. Phone/Fax

Practice location:
  • Phone: 414-906-2700
  • Fax: 414-963-2691
Mailing address:
  • Phone: 414-906-2700
  • Fax: 414-963-2691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number2373
License Number StateWI

VIII. Authorized Official

Name: MS. DEBORAH CLEMENTS BLANKS
Title or Position: CEO
Credential:
Phone: 414-906-2722