NPIMap

Organization Active NPI

Social Rehabilitation and Residential Resources, Inc.

  • Community/Behavioral Health Agency
  • West Allis, WI
National Provider Identifier
1154514776
Registry record updated Aug 27, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
2611 Issued in WI
Legal business name
SOCIAL REHABILITATION AND RESIDENTIAL RESOURCES, INC.
Practice address
9330 W Lincoln Ave Ste 21
West Allis, WI 53227-2300
Phone
(414) 546-6880
Fax
(414) 546-6234
NPI assigned
Aug 27, 2007
Last updated
Aug 27, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 27, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Jeffery Kincaid, MS, LPC
Title
Chief Executive Officer
Phone
(414) 546-6880

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X 2611 WI Primary

Addresses

Primary practice location

9330 W Lincoln Ave Ste 21
West Allis, WI 53227-2300

Mailing address

9330 W Lincoln Ave Ste 21
West Allis, WI 53227-2300
Phone (414) 546-6880

Other identifiers 1

IdentifierTypeStateIssuer
42242500MedicaidWI

National Provider Directory

National Provider Directory
Tax ID family
Social Rehabilitation and Residential Resources Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

9330 W Lincoln Ave
Ste 21
West Allis, WI 53227
Phone (414) 546-6880

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1188172800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1188172800000",
    "number": "1154514776",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9330 W LINCOLN AVE STE 21",
            "city": "WEST ALLIS",
            "state": "WI",
            "postal_code": "532272300",
            "telephone_number": "414-546-6880",
            "fax_number": "414-546-6234"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9330 W LINCOLN AVE STE 21",
            "city": "WEST ALLIS",
            "state": "WI",
            "postal_code": "532272300",
            "telephone_number": "414-546-6880",
            "fax_number": "414-546-6234"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOCIAL REHABILITATION AND RESIDENTIAL RESOURCES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-27",
        "last_updated": "2007-08-27",
        "status": "A",
        "authorized_official_last_name": "KINCAID",
        "authorized_official_first_name": "JEFFERY",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "414-546-6880",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MS, LPC"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "WI",
            "license": "2611",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "42242500",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in West Allis, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.