Organization
LIFE ENHANCEMENT SUPPORTIVE SERVICES COMMUNITY ASSISTANCE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TONYETTA L ROSS BS (DIRECTOR)
(414) 690-0672
Entity
Organization
Contact information
Practice address
6001 W CENTER ST, 201, MILWAUKEE, WI 53210-2154
(414) 690-0672
Mailing address
6001 W CENTER ST, 201, MILWAUKEE, WI 53210-2154
(414) 690-0672
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1184060998
—
WI
Enumeration date
09/04/2015
Last updated
09/04/2015
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