Healthcare Provider Details

I. General information

NPI: 1801341144
Provider Name (Legal Business Name): FLY PHILANTHROPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2016
Last Update Date: 08/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3352 N PALMER ST
MILWAUKEE WI
53212-1541
US

IV. Provider business mailing address

3352 N PALMER ST
MILWAUKEE WI
53212-1541
US

V. Phone/Fax

Practice location:
  • Phone: 414-678-8767
  • Fax:
Mailing address:
  • Phone: 414-678-8767
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DELLAREESE WILLIAMS
Title or Position: DIRECTOR
Credential:
Phone: 414-678-8767