Provider Demographics
NPI:1750653754
Name:BEHIND THE SCENES ACTION RESOURCE CENTER LLC,
Entity Type:Organization
Organization Name:BEHIND THE SCENES ACTION RESOURCE CENTER LLC,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMMUNITY PARTNER
Authorized Official - Prefix:MS
Authorized Official - First Name:EBONY
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-531-2409
Mailing Address - Street 1:5136 N 42ND ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53209-5219
Mailing Address - Country:US
Mailing Address - Phone:414-531-2904
Mailing Address - Fax:
Practice Address - Street 1:5136 N 42ND ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53209-5219
Practice Address - Country:US
Practice Address - Phone:414-531-2904
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-07
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
No251B00000XAgenciesCase Management