Provider Demographics
NPI:1760795322
Name:LOVE AND CARE COMMUNITY CENTER LLC
Entity Type:Organization
Organization Name:LOVE AND CARE COMMUNITY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:LE'KEYA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MMHC
Authorized Official - Phone:414-399-7342
Mailing Address - Street 1:5609 W THURSTON AVE
Mailing Address - Street 2:UNIT B
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53218-2433
Mailing Address - Country:US
Mailing Address - Phone:414-399-7342
Mailing Address - Fax:
Practice Address - Street 1:2266 N PROSPECT AVE
Practice Address - Street 2:SUITE 514
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-6319
Practice Address - Country:US
Practice Address - Phone:414-722-3274
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-23
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3700-125101YP2500X
WI7475-1231041C0700X
WI163W00000X
251B00000X, 261QM0801X, 367A00000X
WI120939363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251B00000XAgenciesCase ManagementGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & GynecologyGroup - Multi-Specialty
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1760795322Medicaid
WI1447501994Medicaid
WI1649447327Medicaid
WI1679797534Medicaid
WI1255534061Medicaid
WI1346356953Medicaid