Basic Information
| Provider Information | |||||||||
| NPI: | 1417108747 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WISCONSIN COMMUNITY SERVICES, INC | ||||||||
| LastName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | UNLIMITED POTENTIAL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3732 W. WISCONSIN AVENUE | ||||||||
| Address2: | |||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532083166 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4142900400 | ||||||||
| FaxNumber: | 4142714605 | ||||||||
| Practice Location | |||||||||
| Address1: | 230 W. WELLS ST. | ||||||||
| Address2: | SUITE 500 | ||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532031845 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4142900440 | ||||||||
| FaxNumber: | 4142260351 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/06/2008 | ||||||||
| LastUpdateDate: | 06/11/2014 | ||||||||
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| AuthorizedOfficialLastName: | PATZER | ||||||||
| AuthorizedOfficialFirstName: | HOLLIS | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 4142900400 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | 52D0914885 | WI | N | Laboratories | Clinical Medical Laboratory | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.