St Rose Youth & Family Center Inc

Primary specialty

Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X

License

265012 Issued in WI

Legal business name

ST ROSE YOUTH & FAMILY CENTER INC

Practice address

3801 N 88TH St
Milwaukee, WI 53222-2706

Phone

(414) 466-9450

Fax

(414) 466-0730

NPI assigned

May 16, 2008

Organization subpart

No

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

Authorized official

Name

Jessica J Waldron, MSW

Title

Director of Treatment and Comm SVC

Phone

(414) 466-9450

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

St Rose Youth Family Center Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

• St. Rose Youth & Family Center, Inc

  • Mental Health Counselor
  • Milwaukee, WI
  • NPI 1740460708
  NPD tax ID
• St. Rose Youth and Family Center

  • Community/Behavioral Health Agency
  • Milwaukee, WI
  • NPI 1245647973
  NPD tax ID

Locations

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

{
    "created_epoch": "1210896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1210896000000",
    "number": "1356508535",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3801 N 88TH ST",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532222706",
            "telephone_number": "414-466-9450",
            "fax_number": "414-466-0730"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3801 N 88TH ST",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532222706",
            "telephone_number": "414-466-9450",
            "fax_number": "414-466-0730"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST ROSE YOUTH & FAMILY CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-16",
        "last_updated": "2008-05-16",
        "status": "A",
        "authorized_official_last_name": "WALDRON",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "DIRECTOR OF TREATMENT AND COMM SVC",
        "authorized_official_telephone_number": "414-466-9450",
        "authorized_official_credential": "MSW"
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "WI",
            "license": "265012",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "43017200",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Emotionally Disturbed Childrens' Residential Treatment Facility in Milwaukee, WI
• Providers in Milwaukee, WI by specialty
• Emotionally Disturbed Childrens' Residential Treatment Facility in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2008; 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.