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General NPI Number Information
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NPI Number | 1154133494
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Entity Type | Organization
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Legal Business Name | BRING BACK LIFE OUTREACH SERVICES, INC
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Dates
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Enumeration Date | 01/23/2025
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Last Update Date | 01/23/2025
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Provider Practice Location Address
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Address Line | 4401 W SPENCER PL
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City | MILWAUKEE
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State | WI
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Zip | 53216-2450
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Country | US
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Telephone | 414-377-1738
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Fax |
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Provider Business Mailing Address
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Address Line | N84W15920 MENOMONEE AVE APT 107
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City | MENOMONEE FALLS
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State | WI
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Zip | 53051-3069
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Country | US
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Telephone | 414-377-1738
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. CHRISTOPHER MARTIN
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Credential |
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Telephone | 262-751-7226
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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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Taxonomy #2
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 333300000X
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Taxonomy Name | Emergency Response System Companies
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 385HR2050X
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Taxonomy Name | Respite Care Camp
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 385HR2060X
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Taxonomy Name | Child Intellectual and/or Developmental Disabilities Respite Care
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 385HR2065X
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Taxonomy Name | Child Physical Disabilities Respite Care
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number |
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License Number State |
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