Provider Demographics
NPI:1770176067
Name:HEAVEN SENT PRENATAL CARE AGENCY
Entity type:Organization
Organization Name:HEAVEN SENT PRENATAL CARE AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIUS
Authorized Official - Middle Name:R
Authorized Official - Last Name:MALONE
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:262-599-4683
Mailing Address - Street 1:9418 N GREEN BAY RD APT 333
Mailing Address - Street 2:
Mailing Address - City:BROWN DEER
Mailing Address - State:WI
Mailing Address - Zip Code:53209-1072
Mailing Address - Country:US
Mailing Address - Phone:262-599-4683
Mailing Address - Fax:
Practice Address - Street 1:9418 N GREEN BAY RD APT 333
Practice Address - Street 2:
Practice Address - City:BROWN DEER
Practice Address - State:WI
Practice Address - Zip Code:53209-1072
Practice Address - Country:US
Practice Address - Phone:262-599-4683
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-17
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management