Provider Demographics
NPI:1659536571
Name:SEEDS OF HEALTH, INC
Entity Type:Organization
Organization Name:SEEDS OF HEALTH, INC
Other - Org Name:SEEDS OF HEALTH WIC
Other - Org Type:Other Name
Authorized Official - Title/Position:WIC PROGRAM DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MURR
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:414-385-5611
Mailing Address - Street 1:1445 S 32ND ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-1903
Mailing Address - Country:US
Mailing Address - Phone:414-385-5611
Mailing Address - Fax:414-672-6885
Practice Address - Street 1:1445 S 32ND ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215-1903
Practice Address - Country:US
Practice Address - Phone:414-385-5611
Practice Address - Fax:414-672-6885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-21
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI251B00000X251B00000X
WI25734595251K00000X
WI251S00000X251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI44012300Medicaid