=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205368099
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BABYNME LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/30/2017
-----------------------------------------------------
Last Update Date | 03/30/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 500 W SILVER SPRING DR SUITE 200
-----------------------------------------------------
City | GLENDALE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53217-5051
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-702-8339
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 500 W SILVER SPRING DR SUITE 200
-----------------------------------------------------
City | GLENDALE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53217-5051
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-702-8339
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | MRS. PAULA NASH
-----------------------------------------------------
Credential | CNA
-----------------------------------------------------
Telephone | 262-353-1910
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number | 222542
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------