Provider Demographics
NPI:1699363283
Name:MOMS FIRST CHOICE LLC
Entity Type:Organization
Organization Name:MOMS FIRST CHOICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:D
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-357-1422
Mailing Address - Street 1:7717 W GOOD HOPE RD APT 108
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53223-4505
Mailing Address - Country:US
Mailing Address - Phone:262-357-1422
Mailing Address - Fax:
Practice Address - Street 1:7717 W GOOD HOPE RD APT 108
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53223-4505
Practice Address - Country:US
Practice Address - Phone:262-357-1422
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-08
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100133091Medicaid