Provider Demographics
NPI:1275314379
Name:SAVING OUR SONS MENTORING MOVEMENT INC
Entity Type:Organization
Organization Name:SAVING OUR SONS MENTORING MOVEMENT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:JERMAINE
Authorized Official - Last Name:AMBROSE
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:262-623-0572
Mailing Address - Street 1:790 N MILWAUKEE ST STE 353
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-4072
Mailing Address - Country:US
Mailing Address - Phone:262-345-7933
Mailing Address - Fax:
Practice Address - Street 1:790 N MILWAUKEE ST STE 353
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-4072
Practice Address - Country:US
Practice Address - Phone:262-345-7933
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-13
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health