Provider Demographics
NPI:1104622620
Name:KENOSHA HUMAN DEVELOPMENT SERVICES, INC
Entity type:Organization
Organization Name:KENOSHA HUMAN DEVELOPMENT SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEANNINE
Authorized Official - Middle Name:M
Authorized Official - Last Name:FIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-764-8512
Mailing Address - Street 1:3536 52ND ST
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53144-2662
Mailing Address - Country:US
Mailing Address - Phone:262-764-8555
Mailing Address - Fax:262-653-2080
Practice Address - Street 1:3536 52ND ST
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53144-2662
Practice Address - Country:US
Practice Address - Phone:262-764-8555
Practice Address - Fax:262-653-2080
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KENOSHA HUMAN DEVELPOMENT SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-02-24
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251B00000XAgenciesCase ManagementGroup - Multi-Specialty