Provider Demographics
NPI:1699314864
Name:JOYCE'S HOUSE OF MILWAUKEE
Entity type:Organization
Organization Name:JOYCE'S HOUSE OF MILWAUKEE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MERCEDEZ
Authorized Official - Middle Name:
Authorized Official - Last Name:BUTTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-286-9055
Mailing Address - Street 1:PO BOX 511402
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53203-0241
Mailing Address - Country:US
Mailing Address - Phone:414-286-9055
Mailing Address - Fax:
Practice Address - Street 1:2811 W NORTH AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53208-1551
Practice Address - Country:US
Practice Address - Phone:414-286-9055
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-05
Last Update Date:2020-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder