Provider Demographics
NPI:1508515222
Name:COMFORT OUTREACH CLINIC, LLC
Entity Type:Organization
Organization Name:COMFORT OUTREACH CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SUNDAY
Authorized Official - Middle Name:
Authorized Official - Last Name:KEROBO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-426-5846
Mailing Address - Street 1:9809 W FOUNTAIN AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53224-3354
Mailing Address - Country:US
Mailing Address - Phone:414-426-5846
Mailing Address - Fax:414-377-0528
Practice Address - Street 1:3500 N SHERMAN BLVD STE 201
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53216-3463
Practice Address - Country:US
Practice Address - Phone:414-426-5846
Practice Address - Fax:414-377-0528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-21
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management