Provider Demographics
NPI:1467848580
Name:PARENT CARE RESOURCE CENTER
Entity Type:Organization
Organization Name:PARENT CARE RESOURCE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:
Authorized Official - Last Name:GANDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-373-8003
Mailing Address - Street 1:3535 W STATE ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53208-3233
Mailing Address - Country:US
Mailing Address - Phone:262-373-8003
Mailing Address - Fax:
Practice Address - Street 1:3535 W STATE ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53208-3233
Practice Address - Country:US
Practice Address - Phone:262-373-8003
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-15
Last Update Date:2015-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management