=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730413345
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BENEDICT CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/29/2009
-----------------------------------------------------
Last Update Date | 09/29/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 135 W WELLS ST SUITE 700
-----------------------------------------------------
City | MILWAUKEE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53203-1830
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-347-1774
-----------------------------------------------------
Fax | 414-347-0148
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 135 W WELLS ST SUITE 700
-----------------------------------------------------
City | MILWAUKEE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53203-1830
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-347-1774
-----------------------------------------------------
Fax | 414-347-0148
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | MS. KIT MURPHY MCNALLY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 414-347-1774
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | 2456
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------