Provider Demographics
NPI:1164673133
Name:FOKUS FAMILY SERVICES LLC
Entity Type:Organization
Organization Name:FOKUS FAMILY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ELZORA
Authorized Official - Middle Name:DARLENE
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:BS,CSAC-ICS
Authorized Official - Phone:414-264-4217
Mailing Address - Street 1:2821 N VEL R PHILLIPS AVE STE 123
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53212-2370
Mailing Address - Country:US
Mailing Address - Phone:414-264-4217
Mailing Address - Fax:414-264-4218
Practice Address - Street 1:2821 N VEL R PHILLIPS AVE STE 123
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53212-2370
Practice Address - Country:US
Practice Address - Phone:414-264-4217
Practice Address - Fax:414-264-4218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-08
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2473251S00000X
261QM0801X
WI52D2043078291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251S00000XAgenciesCommunity/Behavioral Health
No291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI2479OtherMEDICARE PTAN
WI42247800Medicaid
WI2479OtherMEDICARE PTAN