Provider Demographics
NPI:1467931691
Name:THE SALVATION ARMY - WISCONSIN AND UPPER MICHIGAN
Entity Type:Organization
Organization Name:THE SALVATION ARMY - WISCONSIN AND UPPER MICHIGAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIVISIONAL COMMANDER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:MERRITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-302-4300
Mailing Address - Street 1:1730 N 7TH STREET
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53205
Mailing Address - Country:US
Mailing Address - Phone:414-265-6360
Mailing Address - Fax:414-265-8151
Practice Address - Street 1:1730 N 7TH STREET
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53205
Practice Address - Country:US
Practice Address - Phone:414-265-6360
Practice Address - Fax:414-265-8151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-08
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4340-125101YM0800X
WI52683-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty