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NPI Code Detail

MEDICARE: PENFIELD CHILDREN'S CENTER, INC.

MEDICARE: PENFIELD CHILDREN'S CENTER, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)
2261Q00000XClinic/CenterWI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1275692410
Entity Type Code : Organization
Provider Name (Legal Business Name) : PENFIELD CHILDREN'S CENTER, INC.
Provider Business Mailing Address
First Line : 833 N 26TH ST
Second Line :
City : MILWAUKEE
State : WI
Zip : 53233-1507
Country : US
Telephone Number : 414-344-7676
Fax Number : 414-344-7739
Provider Business Practice Location Address
First Line : 833 N 26TH ST
Second Line :
City : MILWAUKEE
State : WI
Zip : 53233-1507
Country : US
Telephone Number : 414-344-7676
Fax Number : 414-344-7739
Authorized Official
Title or Position : PRESIDENT & CEO
Name : MRS. POLINA MAKIEVSKY
Credential :
Telephone Number : 414-345-6300
Provider Enumeration Date : 12/06/2006
Last Update Date : 04/24/2025

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