Provider Demographics
NPI:1346415445
Name:CARMELITE HOME, INC
Entity Type:Organization
Organization Name:CARMELITE HOME, INC
Other - Org Name:CARMELITE HOME FOR BOYS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:E
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:MSWICSW
Authorized Official - Phone:414-258-4791
Mailing Address - Street 1:1214 KAVANAUGH PL
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53213-2506
Mailing Address - Country:US
Mailing Address - Phone:414-258-4791
Mailing Address - Fax:414-258-8464
Practice Address - Street 1:1214 KAVANAUGH PL
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53213-2506
Practice Address - Country:US
Practice Address - Phone:414-258-4791
Practice Address - Fax:414-258-8464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43016800Other43016800 NPI PROVIDER # (OLD)