Provider Demographics
NPI:1467174862
Name:BUILDING LOVE AND SUPPORT FOR MOMS
Entity Type:Organization
Organization Name:BUILDING LOVE AND SUPPORT FOR MOMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRENATAL CARE COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:RONDA
Authorized Official - Middle Name:P
Authorized Official - Last Name:OLIVER -CROSBY
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:414-704-9665
Mailing Address - Street 1:9600 W LANGLADE ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53225-1627
Mailing Address - Country:US
Mailing Address - Phone:414-704-9665
Mailing Address - Fax:
Practice Address - Street 1:10855 W PARK PL
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53224-3600
Practice Address - Country:US
Practice Address - Phone:414-704-9665
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-13
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service