Provider Demographics
NPI:1306014709
Name:ROSALIE MANOR COMMUNITY & FAMILY SERVICES, INC.
Entity Type:Organization
Organization Name:ROSALIE MANOR COMMUNITY & FAMILY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ALBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-449-2868
Mailing Address - Street 1:4803 W BURLEIGH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53210-1643
Mailing Address - Country:US
Mailing Address - Phone:414-449-2868
Mailing Address - Fax:414-449-2870
Practice Address - Street 1:4803 W BURLEIGH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53210-1643
Practice Address - Country:US
Practice Address - Phone:414-449-2868
Practice Address - Fax:414-449-2870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-19
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI44017700Medicaid