Organization
SOCIAL REHABILITATION AND RESIDENTIAL RESOURCES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JEFFERY KINCAID MS, LPC (CHIEF EXECUTIVE OFFICER)
(414) 546-6880
Entity
Organization
Contact information
Practice address
9330 W LINCOLN AVE STE 21, WEST ALLIS, WI 53227-2300
(414) 546-6880
(414) 546-6234
Mailing address
9330 W LINCOLN AVE STE 21, WEST ALLIS, WI 53227-2300
(414) 546-6880
(414) 546-6234
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
2611
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42242500
—
WI
Enumeration date
08/27/2007
Last updated
08/27/2007
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