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General NPI Number Information
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NPI Number | 1255958781
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Entity Type | Organization
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Legal Business Name | FAMILY CONNECTIONS RESOURCE CENTER LLC
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Dates
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Enumeration Date | 06/30/2020
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Last Update Date | 06/30/2020
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Provider Practice Location Address
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Address Line | 6830 W VILLARD AVE STE 301
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City | MILWAUKEE
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State | WI
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Zip | 53218-3968
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Country | US
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Telephone | 414-499-7270
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Fax |
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Provider Business Mailing Address
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Address Line | 6830 W VILLARD AVE STE 301
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City | MILWAUKEE
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State | WI
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Zip | 53218-3968
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Country | US
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Telephone | 414-499-7270
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Fax |
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | CARLA DAVIS
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Credential |
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Telephone | 414-499-7270
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number |
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License Number State |
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