Organization
THE PROVIDERS' GROUP INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TATIA P JACKSON (EXCUTIVE DIRECTOR)
(414) 732-8636
Entity
Organization
Contact information
Practice address
3429 N 1ST ST, MILWAUKEE, WI 53212-1528
(414) 732-8636
Mailing address
3429 N 1ST ST, MILWAUKEE, WI 53212-1528
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
305S00000X
Point of Service
Primary
—
—
Other
Enumeration date
12/24/2010
Last updated
12/24/2010
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