Organization
SAM'S HPUSE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIANE SANDER-GRAY (MANAGER)
12625271282
Entity
Organization
Contact information
Practice address
505 N 26TH ST, MILWAUKEE, WI 53233-2528
(262) 262-5271
Mailing address
PO BOX 13201, WAUWATOSA, WI 53213-0201
(262) 262-5271
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
251S00000X
Community/Behavioral Health Agency
—
—
Other
Enumeration date
06/30/2014
Last updated
06/30/2014
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