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General NPI Number Information
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NPI Number | 1114548542
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Entity Type | Organization
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Legal Business Name | ABBY'S CLUBHOUSE / ABBY BOO INC
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Dates
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Enumeration Date | 04/27/2020
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Last Update Date | 02/05/2021
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Provider Practice Location Address
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Address Line | 2640 W FONDULAC AVE
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City | MILWAUKEE
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State | WI
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Zip | 53206
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Country | US
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Telephone | 414-514-3651
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1052
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City | MILWAUKEE
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State | WI
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Zip | 53201-1052
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CAPRICE MATHIES
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Credential |
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Telephone | 414-242-1174
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State |
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