Healthcare Provider Details

I. General information

NPI: 1497093520
Provider Name (Legal Business Name): WORD OF HOPE MINISTRIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2013
Last Update Date: 01/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2677 N 40TH ST
MILWAUKEE WI
53210-2505
US

IV. Provider business mailing address

2677 N 40TH ST
MILWAUKEE WI
53210-2505
US

V. Phone/Fax

Practice location:
  • Phone: 414-447-1965
  • Fax: 414-447-1964
Mailing address:
  • Phone: 414-447-1965
  • Fax: 414-447-1964

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number15653-130
License Number StateWI

VIII. Authorized Official

Name: MS. PATRICIA LOUISE GRAY
Title or Position: SUBSTANCE ABUSE COUNSELOR
Credential: 15653-130
Phone: 414-447-1965