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General NPI Number Information
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NPI Number | 1285157529
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Entity Type | Organization
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Legal Business Name | FIRST CLASS CARE WISCONSIN LLC
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Dates
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Enumeration Date | 07/19/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 5441 N 73RD ST
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City | MILWAUKEE
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State | WI
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Zip | 53218-2826
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Country | US
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Telephone | 414-763-2072
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Fax |
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Provider Business Mailing Address
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Address Line | 5441 N 73RD ST
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City | MILWAUKEE
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State | WI
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Zip | 53218-2826
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Country | US
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Telephone | 414-763-2072
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Fax |
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Authorized Official
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Title or Position | CO OWNER
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Name | MR. IGONI IGONI
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Credential |
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Telephone | 414-763-2072
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD1600X
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Taxonomy Name | Developmental Disabilities Clinic/Center
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License Number | 0015719
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License Number State | WI
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