Healthcare Provider Details

I. General information

NPI: 1396282562
Provider Name (Legal Business Name): 4MOTHERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2017
Last Update Date: 01/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5226 W HAMPTON AVE
MILWAUKEE WI
53218-5016
US

IV. Provider business mailing address

5226 W HAMPTON AVE
MILWAUKEE WI
53218-5016
US

V. Phone/Fax

Practice location:
  • Phone: 414-585-9896
  • Fax:
Mailing address:
  • Phone: 414-585-9896
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: AUBREY ZAILNER
Title or Position: PROGRAM MANAGER
Credential:
Phone: 414-585-9896