Provider Demographics
NPI:1962682641
Name:PROJECT ACCESS, INC
Entity Type:Organization
Organization Name:PROJECT ACCESS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:G. ROGER
Authorized Official - Middle Name:
Authorized Official - Last Name:ZHONG
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:414-456-1155
Mailing Address - Street 1:809 S 60TH ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53214-3363
Mailing Address - Country:US
Mailing Address - Phone:414-456-1155
Mailing Address - Fax:414-456-1655
Practice Address - Street 1:809 S 60TH ST
Practice Address - Street 2:SUITE 201
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53214-3363
Practice Address - Country:US
Practice Address - Phone:414-456-1155
Practice Address - Fax:414-456-1655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-09
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43427900Medicaid