Provider Demographics
NPI:1922711340
Name:FAMILY TIES PRENATAL CARE LLC
Entity Type:Organization
Organization Name:FAMILY TIES PRENATAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TAMIKO
Authorized Official - Middle Name:
Authorized Official - Last Name:WILDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-732-5160
Mailing Address - Street 1:5215 N IRONWOOD RD STE 202
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53217-4908
Mailing Address - Country:US
Mailing Address - Phone:414-338-6119
Mailing Address - Fax:
Practice Address - Street 1:5215 N IRONWOOD RD STE 202
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53217-4908
Practice Address - Country:US
Practice Address - Phone:414-338-6119
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-30
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing