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NPI Code Detail

MEDICARE: LAURA ANGEL'S COMMUNITY PROJECT LLC

MEDICARE: LAURA ANGEL'S COMMUNITY PROJECT 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
1251B00000XCase Management Agency

General Provider Information

NPI Number : 1588021695
Entity Type Code : Organization
Provider Name (Legal Business Name) : LAURA ANGEL'S COMMUNITY PROJECT LLC
Provider Business Mailing Address
First Line : 7149 W GRANTOSA CT
Second Line :
City : MILWAUKEE
State : WI
Zip : 53218-3947
Country : US
Telephone Number : 414-380-1334
Fax Number :
Provider Business Practice Location Address
First Line : 7149 W GRANTOSA CT
Second Line :
City : MILWAUKEE
State : WI
Zip : 53218-3947
Country : US
Telephone Number : 414-380-1334
Fax Number :
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : QUIANA J ROBINSON
Credential :
Telephone Number : 414-380-1334
Provider Enumeration Date : 01/20/2016
Last Update Date : 02/10/2016

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Directions to “LAURA ANGEL'S COMMUNITY PROJECT LLC ” Practice Location

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