1184498057 NPI number — READY SET GROW PRENATAL CARE COORDINATION STUDIO

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184498057 NPI number — READY SET GROW PRENATAL CARE COORDINATION STUDIO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
READY SET GROW PRENATAL CARE COORDINATION STUDIO
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184498057
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/28/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2155 W MILL RD APT 208
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GLENDALE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53209-3462
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
414-610-1886
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6091 N TEUTONIA AVE STE 105
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILWAUKEE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53209-3644
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
262-825-2470
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/13/2023

Additional Information

Authorized Official

Authorized Official Last Name:
JUDE
Authorized Official First Name:
SHIRRON
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT & CEO
Authorized Official Telephone Number:
414-610-1886

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100285832 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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