Provider Demographics
NPI:1770896177
Name:SUPERIOR MOTHERS
Entity type:Organization
Organization Name:SUPERIOR MOTHERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KATAWNA
Authorized Official - Middle Name:E
Authorized Official - Last Name:LOWE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-852-2077
Mailing Address - Street 1:P.O. BOX 1
Mailing Address - Street 2:N115 W16895 EL CAMINO DRIVE
Mailing Address - City:GERMANTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53022
Mailing Address - Country:US
Mailing Address - Phone:414-852-2077
Mailing Address - Fax:
Practice Address - Street 1:N115W16895 EL CAMINO DR
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:WI
Practice Address - Zip Code:53022-3231
Practice Address - Country:US
Practice Address - Phone:414-852-2077
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-14
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty