MEDICARE: CHARACTER BUILDERS LLC

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

General Provider Information

NPI Number	:	1346645173
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHARACTER BUILDERS LLC

Provider Business Mailing Address
First Line	:	4510 W OLIVE ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53216-1400
Country	:	US
Telephone Number	:	414-241-8792
Fax Number	:	414-434-3068

Provider Business Practice Location Address
First Line	:	4510 W OLIVE ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53216-1400
Country	:	US
Telephone Number	:	414-241-8792
Fax Number	:	414-434-3068

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	MS. LATONIA LORRAINE GREEN
Credential	:
Telephone Number	:	414-241-8792

Provider Enumeration Date	:	10/22/2014
Last Update Date	:	10/22/2014

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Directions to “CHARACTER BUILDERS LLC ” Practice Location

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