Provider Demographics
NPI:1760638951
Name:SUPPORTIVE COMMUNITY SERVICES, INC.
Entity Type:Organization
Organization Name:SUPPORTIVE COMMUNITY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LANGENWALTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-475-2666
Mailing Address - Street 1:1126 S 70TH ST STE S106
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53214-3159
Mailing Address - Country:US
Mailing Address - Phone:414-475-2666
Mailing Address - Fax:414-475-2670
Practice Address - Street 1:1126 S 70TH ST STE S106
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53214-3159
Practice Address - Country:US
Practice Address - Phone:414-475-2666
Practice Address - Fax:414-475-2670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-07
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2192-800251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management