MEDICARE: SEEDS OF HEALTH, 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
1	251B00000X	Case Management Agency	251B00000X	WI
2	251S00000X	Community/Behavioral Health Agency	251S00000X	WI
3	251K00000X	Public Health or Welfare Agency	25734595	WI

Other Identifiers

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

General Provider Information

NPI Number	:	1659536571
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SEEDS OF HEALTH, INC

Provider Business Mailing Address
First Line	:	1445 S 32ND ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53215-1903
Country	:	US
Telephone Number	:	414-385-5611
Fax Number	:	414-672-6885

Provider Business Practice Location Address
First Line	:	1445 S 32ND ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53215-1903
Country	:	US
Telephone Number	:	414-385-5611
Fax Number	:	414-672-6885

Authorized Official
Title or Position	:	WIC PROGRAM DIRECTOR
Name	:	MS. CHRISTINE ANN MURR
Credential	:	R.D.
Telephone Number	:	414-385-5611

Provider Enumeration Date	:	07/21/2008
Last Update Date	:	02/06/2012

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Directions to “SEEDS OF HEALTH, INC ” Practice Location

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