Healthcare Provider Details

I. General information

NPI: 1861359523
Provider Name (Legal Business Name): ANGELS OF MENTALLY CHALLENGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2026
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2708 W CENTER ST APT 200
MILWAUKEE WI
53210-2648
US

IV. Provider business mailing address

2708 W CENTER ST APT 200
MILWAUKEE WI
53210-2648
US

V. Phone/Fax

Practice location:
  • Phone: 601-741-7568
  • Fax:
Mailing address:
  • Phone: 601-741-7568
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name: GLORIA GUY
Title or Position: OWNER
Credential:
Phone: 601-741-7568