Provider Demographics
NPI:1518134055
Name:ASHA FAMILY SERVICES, INC.
Entity type:Organization
Organization Name:ASHA FAMILY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:SCAGGS
Authorized Official - Suffix:
Authorized Official - Credentials:CCS
Authorized Official - Phone:414-875-1511
Mailing Address - Street 1:3821 W NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53208-1352
Mailing Address - Country:US
Mailing Address - Phone:414-875-1511
Mailing Address - Fax:414-875-1217
Practice Address - Street 1:3821 W NORTH AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53208-1352
Practice Address - Country:US
Practice Address - Phone:414-875-1511
Practice Address - Fax:414-875-1217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-14
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2239251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI44015900Medicaid