Provider Demographics
NPI:1962891994
Name:KLS COMMUNITY OUTREACH TEEN CENTER CONSULTING AND MANAGEMENT L.L.C.
Entity type:Organization
Organization Name:KLS COMMUNITY OUTREACH TEEN CENTER CONSULTING AND MANAGEMENT L.L.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:KENYA
Authorized Official - Middle Name:LATRICE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-236-5278
Mailing Address - Street 1:8330 NORTH TEUTONIA AVE SUITE 103
Mailing Address - Street 2:
Mailing Address - City:BROWN DEER
Mailing Address - State:WI
Mailing Address - Zip Code:53209
Mailing Address - Country:US
Mailing Address - Phone:414-236-5278
Mailing Address - Fax:414-368-3051
Practice Address - Street 1:8330 NORTH TEUTONIA AVE SUITE 103
Practice Address - Street 2:
Practice Address - City:BROWN DEER
Practice Address - State:WI
Practice Address - Zip Code:53209
Practice Address - Country:US
Practice Address - Phone:414-236-5278
Practice Address - Fax:414-368-3051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-14
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
No251K00000XAgenciesPublic Health or Welfare
No251S00000XAgenciesCommunity/Behavioral Health