Provider Demographics
NPI:1558176511
Name:GIBWATER ENTERPRISES LLC
Entity type:Organization
Organization Name:GIBWATER ENTERPRISES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:ROSS
Authorized Official - Middle Name:
Authorized Official - Last Name:FRESHWATER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-931-0000
Mailing Address - Street 1:2009 N 56TH ST # WI53208
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53208-1609
Mailing Address - Country:US
Mailing Address - Phone:414-931-1372
Mailing Address - Fax:
Practice Address - Street 1:2009 N 56TH ST # WI53208
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53208-1609
Practice Address - Country:US
Practice Address - Phone:414-931-0000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-07
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty