Provider Demographics
NPI:1346047164
Name:MOMMYS BEAUTIFUL SUNRISE INC
Entity type:Organization
Organization Name:MOMMYS BEAUTIFUL SUNRISE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTOR DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANICE
Authorized Official - Middle Name:
Authorized Official - Last Name:BAQUET
Authorized Official - Suffix:
Authorized Official - Credentials:HOLISTIC PR
Authorized Official - Phone:262-457-9815
Mailing Address - Street 1:2656 N TEUTONIA AVE # 6566
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53206-9998
Mailing Address - Country:US
Mailing Address - Phone:262-457-9815
Mailing Address - Fax:
Practice Address - Street 1:8430 W CAPITOL DR STE 3025
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53222-1846
Practice Address - Country:US
Practice Address - Phone:262-457-9815
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-27
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management