Healthcare Provider Details

I. General information

NPI: 1902611841
Provider Name (Legal Business Name): HOUSE OF PURPOSE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2025
Last Update Date: 02/10/2025
Certification Date: 02/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2772 N MLK DR STE 106
MILWAUKEE WI
53212-2312
US

IV. Provider business mailing address

2975 RIVER BIRCH DR UNIT F
BROOKFIELD WI
53045-3491
US

V. Phone/Fax

Practice location:
  • Phone: 414-607-2662
  • Fax:
Mailing address:
  • Phone: 414-607-2662
  • 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 Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number StateNULL

VIII. Authorized Official

Name: LONDELL DALLAS
Title or Position: OWNER
Credential:
Phone: 414-607-2662