Healthcare Provider Details

I. General information

NPI: 1073839528
Provider Name (Legal Business Name): EASTER SEALS SOUTHEAST WISCONSIN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2010
Last Update Date: 04/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1016 MILWAUKEE AVE
SOUTH MILWAUKEE WI
53172-2006
US

IV. Provider business mailing address

1016 MILWAUKEE AVE
SOUTH MILWAUKEE WI
53172-2006
US

V. Phone/Fax

Practice location:
  • Phone: 414-571-5566
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT GLOWACKI
Title or Position: CEO
Credential:
Phone: 414-571-5566