=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518556158
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | A NEW WAY 2 LIVE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/17/2021
-----------------------------------------------------
Last Update Date | 01/17/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2417 SPRINGDALE RD APT 3A
-----------------------------------------------------
City | WAUKESHA
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53186-2764
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-676-4381
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2417 SPRINGDALE RD APT 3A
-----------------------------------------------------
City | WAUKESHA
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53186-2764
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-676-4381
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER OPERATOR
-----------------------------------------------------
Name | MS. ZAKKIYYA FAHMEEDA SALAHADYN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 414-676-4381
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------