Healthcare Provider Details

I. General information

NPI: 1770446718
Provider Name (Legal Business Name): NUMBER OF THIS NOTICE: CP 575 G BLESSED N BEAUTIFUL BEGINNINGS PRENATAL CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2025
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4107 W NORTH AVE
MILWAUKEE WI
53208-1320
US

IV. Provider business mailing address

4107 W NORTH AVE
MILWAUKEE WI
53208-1320
US

V. Phone/Fax

Practice location:
  • Phone: 414-736-2682
  • Fax:
Mailing address:
  • Phone: 414-736-2682
  • 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 TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: BRIDGET FARROW-RODRIQUEZ
Title or Position: OWNER
Credential:
Phone: 414-736-2682