Provider Demographics
NPI:1508027905
Name:WISCONSIN COMMUNITY SERVICES, INC.
Entity Type:Organization
Organization Name:WISCONSIN COMMUNITY SERVICES, INC.
Other - Org Name:UNLIMITED POTENTIAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:HOLLIS
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:PATZER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-290-0400
Mailing Address - Street 1:3732 W. WISCONSIN AVENUE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53208-3166
Mailing Address - Country:US
Mailing Address - Phone:414-290-0400
Mailing Address - Fax:414-271-4605
Practice Address - Street 1:230 W. WELLS ST.
Practice Address - Street 2:SUITE 500
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53203-1845
Practice Address - Country:US
Practice Address - Phone:414-290-0440
Practice Address - Fax:414-226-0351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-19
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI52D0914885291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32920400Medicaid