Provider Demographics
NPI:1295901528
Name:THE INSTITUTE FOR SOCIAL ADVANCEMENT
Entity type:Organization
Organization Name:THE INSTITUTE FOR SOCIAL ADVANCEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHUCK
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLLOWAY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:414-449-9908
Mailing Address - Street 1:PO BOX 274
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53201-0274
Mailing Address - Country:US
Mailing Address - Phone:414-449-9908
Mailing Address - Fax:414-449-9912
Practice Address - Street 1:4222 W CAPITOL DR
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53216-2500
Practice Address - Country:US
Practice Address - Phone:414-449-9908
Practice Address - Fax:414-449-9912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-06
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI44018400Medicaid