Provider Demographics
NPI:1609457142
Name:ESSENTIAL ASSISTANCE PRENATAL CARE AGENCY
Entity Type:Organization
Organization Name:ESSENTIAL ASSISTANCE PRENATAL CARE AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARQUES
Authorized Official - Middle Name:
Authorized Official - Last Name:CARROLL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-915-9424
Mailing Address - Street 1:8018 W CAPITOL DR STE 105
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53222-1906
Mailing Address - Country:US
Mailing Address - Phone:414-915-9424
Mailing Address - Fax:414-488-1411
Practice Address - Street 1:8018 W CAPITOL DR STE 105
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53222-1906
Practice Address - Country:US
Practice Address - Phone:414-915-9424
Practice Address - Fax:414-488-1411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-16
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management