Healthcare Provider Details

I. General information

NPI: 1124663299
Provider Name (Legal Business Name): C RENEE CONSULTING AND MANAGEMENT GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2019
Last Update Date: 11/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6090 N 35TH ST STE 204
MILWAUKEE WI
53209-3602
US

IV. Provider business mailing address

6090 N 35TH ST STE 204
MILWAUKEE WI
53209-3602
US

V. Phone/Fax

Practice location:
  • Phone: 414-982-5275
  • Fax: 414-466-2273
Mailing address:
  • Phone: 414-982-5275
  • Fax: 414-466-2273

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. CYNTHIA R BROWN
Title or Position: PRESIDENT/CEO
Credential: MS
Phone: 414-982-5275