Provider Demographics
NPI:1063759306
Name:UNITED COMMUNITY CENTER
Entity type:Organization
Organization Name:UNITED COMMUNITY CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COUNCELER
Authorized Official - Prefix:MS
Authorized Official - First Name:CHANDEL
Authorized Official - Middle Name:ANGELICA
Authorized Official - Last Name:DEMERA
Authorized Official - Suffix:
Authorized Official - Credentials:MS,SAC-IT
Authorized Official - Phone:414-643-8530
Mailing Address - Street 1:111 S 6TH STREET
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53204-2301
Mailing Address - Country:US
Mailing Address - Phone:414-643-8530
Mailing Address - Fax:414-647-8602
Practice Address - Street 1:1028 S 9TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53204-1335
Practice Address - Country:US
Practice Address - Phone:414-643-8530
Practice Address - Fax:414-647-8602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-07
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility