MEDICARE: SAVING OUR SURVIVORS S.O.S

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251B00000X	Case Management Agency	18075130	WI

General Provider Information

NPI Number	:	1003357807
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAVING OUR SURVIVORS S.O.S

Provider Business Mailing Address
First Line	:	2201 N. CAMBRIDGE AVE
Second Line	:	APT 401
City	:	MILWAUKEE
State	:	WI
Zip	:	53202
Country	:	US
Telephone Number	:	262-765-9294
Fax Number	:

Provider Business Practice Location Address
First Line	:	2201 N CAMBRIDGE AVE
Second Line	:	APT 401
City	:	MILWAUKEE
State	:	WI
Zip	:	53202-1047
Country	:	US
Telephone Number	:	262-765-9294
Fax Number	:

Authorized Official
Title or Position	:	SUBSTANCE ABUSE COUNSELOR INTRANNIG
Name	:	MR. DOSHA DJAY JOI
Credential	:	18075-130
Telephone Number	:	262-765-9294

Provider Enumeration Date	:	03/13/2017
Last Update Date	:	03/13/2017

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