Provider Demographics
NPI:1538389184
Name:WISCONSIN COMMUNITY SERVICES INC.
Entity type:Organization
Organization Name:WISCONSIN COMMUNITY SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:COMPTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-290-0420
Mailing Address - Street 1:3734 W. WISCONSIN AVENUE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53208-3166
Mailing Address - Country:US
Mailing Address - Phone:414-290-0400
Mailing Address - Fax:414-271-4605
Practice Address - Street 1:3732 W WISCONSIN AVE STE 200
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53208-3166
Practice Address - Country:US
Practice Address - Phone:414-344-6111
Practice Address - Fax:414-344-2191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI251S00000X
291U00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42107800Medicaid