Healthcare Provider Details

I. General information

NPI: 1821489972
Provider Name (Legal Business Name): CENTER FOR FAMILY PRESERVATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2015
Last Update Date: 02/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6737 N TEUTONIA AVE
MILWAUKEE WI
53209-3118
US

IV. Provider business mailing address

6737 N TEUTONIA AVE
MILWAUKEE WI
53209-3118
US

V. Phone/Fax

Practice location:
  • Phone: 414-540-9750
  • Fax:
Mailing address:
  • Phone: 414-540-9750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: ARTHUR KENNEDY
Title or Position: DIRECTOR
Credential:
Phone: 414-540-9750