Provider Demographics
NPI:1639821739
Name:BURMESE ROHINGYA COMMUNITY OF WISCONSIN INC.
Entity Type:Organization
Organization Name:BURMESE ROHINGYA COMMUNITY OF WISCONSIN INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/ ADM. DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:TRUMBULL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-502-8893
Mailing Address - Street 1:2009 S LAYTON BLVD
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-2256
Mailing Address - Country:US
Mailing Address - Phone:414-502-8893
Mailing Address - Fax:
Practice Address - Street 1:2330 W SCOTT ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53204-1929
Practice Address - Country:US
Practice Address - Phone:414-502-8893
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-20
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1000XAmbulatory Health Care FacilitiesClinic/CenterMigrant Health