Organization
PROSPEROUS ROADS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KENDRA IVY (ADMINISTRATOR)
(414) 348-9949
Entity
Organization
Contact information
Practice address
7302 N 38TH ST, MILWAUKEE, WI 53209-1939
(414) 739-1180
Mailing address
7302 N 38TH ST, MILWAUKEE, WI 53209-1939
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
02/27/2023
Last updated
02/27/2023
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