Organization
URBAN LEADERS-MKE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LATONYA DISMUKE (DIRECTOR)
(414) 551-7415
Entity
Organization
Contact information
Practice address
5514 W LISBON AVE, MILWAUKEE, WI 53210-2755
(414) 551-7415
Mailing address
5514 W LISBON AVE, MILWAUKEE, WI 53210-2755
(414) 551-7415
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
825825678
—
WI
05
—
82587558
—
WI
Enumeration date
12/03/2019
Last updated
12/13/2019
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