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General NPI Number Information
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NPI Number | 1477192359
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Entity Type | Organization
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Legal Business Name | I'M A STAR YOUTH AND FAMILY SERVICES INC
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Dates
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Enumeration Date | 12/25/2019
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Last Update Date | 12/27/2019
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Provider Practice Location Address
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Address Line | 4007 W NORTH AVE
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City | MILWAUKEE
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State | WI
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Zip | 53208-1318
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Country | US
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Telephone | 414-888-1710
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Fax |
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Provider Business Mailing Address
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Address Line | 2969 N 46TH ST
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City | MILWAUKEE
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State | WI
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Zip | 53210-1727
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Country | US
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Telephone | 414-888-1710
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED AGENT
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Name | SHAKINAS ROBINSON
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Credential |
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Telephone | 414-888-1710
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number |
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License Number State |
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