Organization
GRASSROOTS EMPOWERMENT PROJECT INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MOLLY CISCO (EXECUTIVE DIRECTOR)
(608) 206-5094
Entity
Organization
Contact information
Practice address
3732 W WISCONSIN AVE, MILWAUKEE, WI 53208
(414) 344-0447
(414) 344-0450
Mailing address
PO BOX 8683, MADISON, WI 53708-8683
(800) 770-0588
(800) 770-0588
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
—
Other
Enumeration date
04/30/2012
Last updated
04/30/2012
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