Provider Demographics
NPI:1194057026
Name:HOWARD JANSEN DAY TREATMENT
Entity type:Organization
Organization Name:HOWARD JANSEN DAY TREATMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:LUCEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-527-6970
Mailing Address - Street 1:1744 N FARWELL AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-1806
Mailing Address - Country:US
Mailing Address - Phone:414-225-4460
Mailing Address - Fax:414-225-4475
Practice Address - Street 1:5151 W SILVER SPRING DR
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53218-3300
Practice Address - Country:US
Practice Address - Phone:414-527-6970
Practice Address - Fax:414-527-6971
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHOENIX CARE SYSTEMS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-02-03
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2366251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services