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General NPI Number Information
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NPI Number | 1174323836
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Entity Type | Organization
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Legal Business Name | AUTHENTIC BIRTH CENTER WELLNESS COLLECTIVE LLC
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Dates
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Enumeration Date | 03/13/2025
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Last Update Date | 12/19/2025
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Provider Practice Location Address
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Address Line | 530 N 108TH PL STE 100
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City | WAUWATOSA
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State | WI
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Zip | 53226-4253
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Country | US
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Telephone | 414-231-9640
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Fax | 414-226-5078
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Provider Business Mailing Address
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Address Line | 2864 S WAUKESHA RD
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City | WEST ALLIS
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State | WI
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Zip | 53227-2834
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Country | US
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Telephone | 414-617-3178
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Fax |
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Authorized Official
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Title or Position | COO
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Name | TONY SKARLATOS
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Credential |
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Telephone | 414-617-3178
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QB0400X
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Taxonomy Name | Birthing Clinic/Center
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License Number |
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License Number State |
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