Provider Demographics
NPI:1790379394
Name:THE MOMMY CONNECT PRENATAL CARE SERVICES LLC
Entity Type:Organization
Organization Name:THE MOMMY CONNECT PRENATAL CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GYTESA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-812-5223
Mailing Address - Street 1:342 N WATER ST STE 600
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-5715
Mailing Address - Country:US
Mailing Address - Phone:414-323-6399
Mailing Address - Fax:
Practice Address - Street 1:342 N WATER ST STE 600
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-5715
Practice Address - Country:US
Practice Address - Phone:414-323-6399
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-24
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management