Provider Demographics
NPI:1851972202
Name:LABOR OF LOVE ALLIANCE, LLC
Entity Type:Organization
Organization Name:LABOR OF LOVE ALLIANCE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TAYLOR
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:414-249-9670
Mailing Address - Street 1:7004 W SANDPIPER CT
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53223-2753
Mailing Address - Country:US
Mailing Address - Phone:414-249-9670
Mailing Address - Fax:
Practice Address - Street 1:7004 W SANDPIPER CT
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53223-2753
Practice Address - Country:US
Practice Address - Phone:414-249-9670
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-17
Last Update Date:2021-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100161250Medicaid