Provider Demographics
NPI:1750603296
Name:A NEW LIGHT PRENATAL CARE CENTER
Entity type:Organization
Organization Name:A NEW LIGHT PRENATAL CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPRIETOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUZETTE
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-234-3169
Mailing Address - Street 1:4740 W GREEN TREE RD
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53223-5325
Mailing Address - Country:US
Mailing Address - Phone:414-234-3169
Mailing Address - Fax:
Practice Address - Street 1:1915 N MARTIN LUTHER KING DR
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53212-3675
Practice Address - Country:US
Practice Address - Phone:414-234-3169
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-25
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management