Organization
KINGLY COMMUNITY RESOURCE CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT C RANDOLPH (OWNER)
(414) 899-6838
Entity
Organization
Contact information
Practice address
4200 N HOLTON ST, SUITE 110, MILWAUKEE, WI 53212-1008
(414) 899-6838
(414) 509-7412
Mailing address
4200 N HOLTON ST, SUITE 110, MILWAUKEE, WI 53212-1008
(414) 899-6838
(414) 509-7412
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
Other
Enumeration date
02/13/2017
Last updated
02/13/2017
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