Healthcare Provider Details

I. General information

NPI: 1336818871
Provider Name (Legal Business Name): CB S NP HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2021
Last Update Date: 01/20/2023
Certification Date: 01/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11414 W PARK PL STE 202
MILWAUKEE WI
53224-3500
US

IV. Provider business mailing address

11414 W PARK PL STE 202
MILWAUKEE WI
53224-3500
US

V. Phone/Fax

Practice location:
  • Phone: 414-388-8070
  • Fax:
Mailing address:
  • Phone: 414-212-5693
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CANDACE BENTLEY
Title or Position: OWNER
Credential: NP
Phone: 414-212-5693