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NPI Code Detail

MEDICARE: ASHA FAMILY SERVICES INC

MEDICARE: ASHA FAMILY SERVICES INC
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
1320900000XIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility2239WI
2324500000XSubstance Abuse Rehabilitation Facility2239WI

General Provider Information

NPI Number : 1629345632
Entity Type Code : Organization
Provider Name (Legal Business Name) : ASHA FAMILY SERVICES INC
Provider Business Mailing Address
First Line : 3719 W CENTER ST
Second Line :
City : MILWAUKEE
State : WI
Zip : 53210-2553
Country : US
Telephone Number : 414-875-1511
Fax Number : 414-875-1217
Provider Business Practice Location Address
First Line : 3719 W CENTER ST
Second Line :
City : MILWAUKEE
State : WI
Zip : 53210-2553
Country : US
Telephone Number : 414-875-1511
Fax Number : 414-875-1217
Authorized Official
Title or Position : CEO
Name : MS. ANTONIA A VANN
Credential :
Telephone Number : 414-875-1511
Provider Enumeration Date : 11/18/2011
Last Update Date : 11/18/2011

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Directions to “ASHA FAMILY SERVICES INC ” Practice Location

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