Provider Demographics
NPI:1730364571
Name:FAMILY CARE FISCAL AGENT
Entity type:Organization
Organization Name:FAMILY CARE FISCAL AGENT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:
Authorized Official - Last Name:SPRENGER
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:414-257-4340
Mailing Address - Street 1:7425 HARWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53213-2626
Mailing Address - Country:US
Mailing Address - Phone:414-257-4385
Mailing Address - Fax:414-475-5215
Practice Address - Street 1:7425 HARWOOD AVE
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53213-2626
Practice Address - Country:US
Practice Address - Phone:414-257-4385
Practice Address - Fax:414-475-5215
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANEW HEALTH CARE SERVICES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-28
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251X00000XAgenciesSupports Brokerage