Provider Demographics
NPI:1801407051
Name:BUNDLE OF LOVE PRENATAL LLC
Entity Type:Organization
Organization Name:BUNDLE OF LOVE PRENATAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JASMINE
Authorized Official - Middle Name:PATRICE
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-639-0588
Mailing Address - Street 1:5406 N LOVERS LANE RD
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53225-3006
Mailing Address - Country:US
Mailing Address - Phone:414-639-0588
Mailing Address - Fax:
Practice Address - Street 1:5406 N LOVERS LANE RD
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53225-3006
Practice Address - Country:US
Practice Address - Phone:414-639-0588
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-12
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management