Healthcare Provider Details

I. General information

NPI: 1700557949
Provider Name (Legal Business Name): ABOVE & BEYOND FAMILY RESOURCE AGENCY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2021
Last Update Date: 09/27/2021
Certification Date: 09/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4219 N 22ND ST
MILWAUKEE WI
53209-6715
US

IV. Provider business mailing address

4644 N 53RD ST
MILWAUKEE WI
53218-5011
US

V. Phone/Fax

Practice location:
  • Phone: 414-916-6567
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: NEJIA MITCHELL
Title or Position: OWNER
Credential:
Phone: 414-915-6567