Healthcare Provider Details

I. General information

NPI: 1104367804
Provider Name (Legal Business Name): BABY NETWORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2017
Last Update Date: 11/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3878 N 24TH PL
MILWAUKEE WI
53206-1419
US

IV. Provider business mailing address

3878 N 24TH PL
MILWAUKEE WI
53206-1419
US

V. Phone/Fax

Practice location:
  • Phone: 414-467-9927
  • Fax:
Mailing address:
  • Phone: 414-467-9927
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: LATOYIA GIBSON
Title or Position: OWNER / OPERATOR
Credential:
Phone: 414-467-9927