Provider Demographics
NPI:1821229345
Name:FOSTER CARE YOUTH INDEPENDENCE CENTER OF WISCONSIN, INC
Entity Type:Organization
Organization Name:FOSTER CARE YOUTH INDEPENDENCE CENTER OF WISCONSIN, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:PEKRUL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-264-6290
Mailing Address - Street 1:2433 N HOLTON ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53212-2934
Mailing Address - Country:US
Mailing Address - Phone:414-264-6290
Mailing Address - Fax:414-264-6073
Practice Address - Street 1:2433 N HOLTON ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53212-2934
Practice Address - Country:US
Practice Address - Phone:414-264-6290
Practice Address - Fax:414-264-6073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-31
Last Update Date:2009-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable