Provider Demographics
NPI:1326536509
Name:PHASES OF LIFE
Entity Type:Organization
Organization Name:PHASES OF LIFE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHALON
Authorized Official - Middle Name:
Authorized Official - Last Name:METCALF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-803-8535
Mailing Address - Street 1:4814 N 58TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53218-4244
Mailing Address - Country:US
Mailing Address - Phone:414-803-8535
Mailing Address - Fax:
Practice Address - Street 1:4814 N 58TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53218-4244
Practice Address - Country:US
Practice Address - Phone:414-803-8535
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHASES OF LIFE FAMILY SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-04-24
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management