Healthcare Provider Details

I. General information

NPI: 1558699777
Provider Name (Legal Business Name): KIDS COLLEGE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2009
Last Update Date: 11/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 N 69TH ST
MILWAUKEE WI
53213-3824
US

IV. Provider business mailing address

114 N 69TH ST
MILWAUKEE WI
53213-3824
US

V. Phone/Fax

Practice location:
  • Phone: 414-461-2273
  • Fax:
Mailing address:
  • Phone: 414-461-2273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License NumberB6241127955508
License Number StateWI

VIII. Authorized Official

Name: MRS. CHIKEYIA L BRAZIL
Title or Position: OWNER/BUSINESS OPERATIONS MANAGER
Credential:
Phone: 414-732-8470