Healthcare Provider Details

I. General information

NPI: 1518384783
Provider Name (Legal Business Name): LOVE LIFE YOUTH AND FAMILY SERVICE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2014
Last Update Date: 03/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9261 E W ALLYN ST
MILWAUKEE WI
53206-4444
US

IV. Provider business mailing address

9261 E W ALLYN ST
MILWAUKEE WI
53206-4444
US

V. Phone/Fax

Practice location:
  • Phone: 414-484-6750
  • Fax: 414-446-9921
Mailing address:
  • Phone: 414-484-6750
  • Fax: 414-446-9921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343800000X
TaxonomySecured Medical Transport (VAN)
License Number
License Number StateWI

VIII. Authorized Official

Name: MR. WILLIAM FERGUSON I
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 414-484-6750