Healthcare Provider Details

I. General information

NPI: 1548826159
Provider Name (Legal Business Name): CENTER FOR CHILDHOOD SAFETY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2019
Last Update Date: 05/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

842 S MILITARY AVE
GREEN BAY WI
54304-2114
US

IV. Provider business mailing address

842 S MILITARY AVE
GREEN BAY WI
54304-2114
US

V. Phone/Fax

Practice location:
  • Phone: 920-272-0110
  • Fax:
Mailing address:
  • Phone: 920-272-0110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY HESS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 920-272-0111