=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538834965
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SAVING OURSELVES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/09/2021
-----------------------------------------------------
Last Update Date | 08/09/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2550 N 10TH ST
-----------------------------------------------------
City | MILWAUKEE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53206-3120
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-239-8278
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11113 W FLORIST AVE
-----------------------------------------------------
City | MILWAUKEE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53225-2319
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-350-4109
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | DOROTHY P WILLIAMS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 414-750-4564
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 320600000X
-----------------------------------------------------
Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------