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General NPI Number Information
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NPI Number | 1437325032
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Entity Type | Organization
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Legal Business Name | EXODUS FAMILY SERVICES
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Dates
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Enumeration Date | 05/02/2008
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Last Update Date | 05/02/2008
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Provider Practice Location Address
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Address Line | 3353 N MARTIN LUTHER KING DR
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City | MILWAUKEE
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State | WI
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Zip | 53212-1455
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Country | US
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Telephone | 414-550-9646
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Fax |
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Provider Business Mailing Address
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Address Line | 2556 N SHERMAN BLVD
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City | MILWAUKEE
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State | WI
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Zip | 53210-2948
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Country | US
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Telephone | 414-550-9646
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Fax |
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Authorized Official
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Title or Position | SOCIAL WORKER
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Name | MR. ALEXANDER HARDY
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Credential | MSW
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Telephone | 414-550-9646
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 3084-123
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License Number State | WI
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