Provider Demographics
NPI:1003357807
Name:SAVING OUR SURVIVORS S.O.S
Entity type:Organization
Organization Name:SAVING OUR SURVIVORS S.O.S
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUBSTANCE ABUSE COUNSELOR INTRANNIG
Authorized Official - Prefix:MR
Authorized Official - First Name:DOSHA
Authorized Official - Middle Name:DJAY
Authorized Official - Last Name:JOI
Authorized Official - Suffix:
Authorized Official - Credentials:18075-130
Authorized Official - Phone:262-765-9294
Mailing Address - Street 1:2201 N. CAMBRIDGE AVE
Mailing Address - Street 2:APT 401
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202
Mailing Address - Country:US
Mailing Address - Phone:262-765-9294
Mailing Address - Fax:
Practice Address - Street 1:2201 N CAMBRIDGE AVE
Practice Address - Street 2:APT 401
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-1047
Practice Address - Country:US
Practice Address - Phone:262-765-9294
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-13
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI18075130251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management