Organization
TEAM SELFKINGDOM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SELFKINGDOM ISALLAH (OWNER)
(414) 671-9045
Entity
Organization
Contact information
Practice address
1930 W NASH ST, MILWAUKEE, WI 53206-2417
(312) 546-4966
Mailing address
2852 N 10TH ST, MILWAUKEE, WI 53206-3224
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
332U00000X
Home Delivered Meals
—
—
343900000X
Non-emergency Medical Transport (VAN)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100244229
—
WI
Enumeration date
06/21/2023
Last updated
07/05/2024
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