Provider Demographics
NPI:1922765106
Name:MELANIN MINDED LLC
Entity Type:Organization
Organization Name:MELANIN MINDED LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BASHIR
Authorized Official - Middle Name:R
Authorized Official - Last Name:EASTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-234-8160
Mailing Address - Street 1:1301 N 12TH STREET
Mailing Address - Street 2:05485
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53205
Mailing Address - Country:US
Mailing Address - Phone:414-234-8160
Mailing Address - Fax:
Practice Address - Street 1:2623 NORTH 61ST STREET
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53213
Practice Address - Country:US
Practice Address - Phone:414-234-8160
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-22
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty