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General NPI Number Information
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NPI Number | 1104622620
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Entity Type | Organization
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Legal Business Name | KENOSHA HUMAN DEVELOPMENT SERVICES, INC
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Dates
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Enumeration Date | 02/24/2025
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Last Update Date | 03/28/2025
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Provider Practice Location Address
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Address Line | 3536 52ND ST
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City | KENOSHA
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State | WI
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Zip | 53144-2662
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Country | US
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Telephone | 262-764-8555
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Fax | 262-653-2080
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Provider Business Mailing Address
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Address Line | 3536 52ND ST
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City | KENOSHA
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State | WI
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Zip | 53144-2662
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Country | US
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Telephone | 262-764-8555
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Fax | 262-653-2080
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. JEANNINE M FIELD
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Credential |
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Telephone | 414-764-8512
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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