Provider Demographics
NPI:1144588922
Name:GRASSROOTS EMPOWERMENT PROJECT INC
Entity Type:Organization
Organization Name:GRASSROOTS EMPOWERMENT PROJECT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:CISCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-206-5094
Mailing Address - Street 1:PO BOX 8683
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53708-8683
Mailing Address - Country:US
Mailing Address - Phone:800-770-0588
Mailing Address - Fax:800-770-0588
Practice Address - Street 1:3732 W WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53208
Practice Address - Country:US
Practice Address - Phone:414-344-0447
Practice Address - Fax:414-344-0450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-30
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty