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General NPI Number Information
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NPI Number | 1215816228
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Entity Type | Organization
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Legal Business Name | SOUL NURTURING CARE CENTER LLC
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Dates
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Enumeration Date | 09/02/2025
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Last Update Date | 09/02/2025
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Provider Practice Location Address
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Address Line | 4601 N 45TH ST
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City | MILWAUKEE
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State | WI
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Zip | 53218-5206
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Country | US
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Telephone | 414-708-1078
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Fax | 262-204-8121
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Provider Business Mailing Address
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Address Line | PO BOX 241607
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City | MILWAUKEE
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State | WI
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Zip | 53224-9035
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Country | US
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Telephone | 414-708-1078
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Fax | 262-204-8121
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | TOMIKA MCNEICE
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Credential |
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Telephone | 414-708-1078
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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