| Community Based Residential Facility | |
|
3910 W Burleigh St Milwaukee WI 53210-1816 | |
| (414) 445-3607 | |
| (414) 445-6575 |
| Full Name | Community Based Residential Facility |
|---|---|
| Speciality | Clinic/center - Community Health |
| Location | 3910 W Burleigh St, Milwaukee, Wisconsin |
| Authorized Official Name and Position | Shirley Temple Gladney (ADMINISTRATOR) |
| Authorized Official Contact | 4144453607 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Community Based Residential Facility 3910 W Burleigh St Milwaukee WI 53210-1816 Ph: (414) 445-3607 | Community Based Residential Facility 3910 W Burleigh St Milwaukee WI 53210-1816 Ph: (414) 445-3607 |
| NPI Number | 1003064064 |
|---|---|
| Provider Enumeration Date | 09/03/2008 |
| Last Update Date | 09/03/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003064064 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QC1500X | Clinic/center - Community Health | (Wisconsin) | Primary |
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