Healthcare Provider Details

I. General information

NPI: 1437325032
Provider Name (Legal Business Name): EXODUS FAMILY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2008
Last Update Date: 05/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3353 N MARTIN LUTHER KING DR
MILWAUKEE WI
53212-1455
US

IV. Provider business mailing address

2556 N SHERMAN BLVD
MILWAUKEE WI
53210-2948
US

V. Phone/Fax

Practice location:
  • Phone: 414-550-9646
  • Fax:
Mailing address:
  • Phone: 414-550-9646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number3084-123
License Number StateWI

VIII. Authorized Official

Name: MR. ALEXANDER HARDY
Title or Position: SOCIAL WORKER
Credential: MSW
Phone: 414-550-9646