Provider Demographics
NPI:1033554373
Name:OUR DAILY BREAD COMMUNITY OUTREACH CENTER, INC
Entity Type:Organization
Organization Name:OUR DAILY BREAD COMMUNITY OUTREACH CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE
Authorized Official - Prefix:MRS
Authorized Official - First Name:LEA
Authorized Official - Middle Name:LAVONDA
Authorized Official - Last Name:KYLE-LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-349-4521
Mailing Address - Street 1:6040 W LISBON AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53210-2116
Mailing Address - Country:US
Mailing Address - Phone:414-255-8595
Mailing Address - Fax:414-449-0470
Practice Address - Street 1:6040 W LISBON AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53210-2116
Practice Address - Country:US
Practice Address - Phone:414-255-8595
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-30
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management