| Birds Of A Feather, Inc. | |
|
6530 Sheridan Road Suite # 3 Kenosha WI 53143 | |
| (262) 945-7266 | |
| (262) 605-1404 |
| Full Name | Birds Of A Feather, Inc. |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 6530 Sheridan Road, Kenosha, Wisconsin |
| Authorized Official Name and Position | Tony Curtis Moore (DIRECTOR) |
| Authorized Official Contact | 2629457266 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Birds Of A Feather, Inc. 6530 Sheridan Road Suite # 3 Kenosha WI 53143 Ph: (262) 945-7266 | Birds Of A Feather, Inc. 6530 Sheridan Road Suite # 3 Kenosha WI 53143 Ph: (262) 945-7266 |
| NPI Number | 1649443136 |
|---|---|
| Provider Enumeration Date | 04/07/2008 |
| Last Update Date | 10/26/2022 |
| Certification Date | 10/26/2022 |
| Medicare PECOS PAC ID | 0446626626 |
|---|---|
| Medicare Enrollment ID | O20221012002504 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649443136 | NPI | - | NPPES |
| 39169700 | Medicaid | WI | |
| 42242921 | Medicaid | WI | |
| 42242900 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 2613 (Wisconsin) | Primary |
| Provider Name | Donald A Walters |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1417944216 PECOS PAC ID: 1658565262 Enrollment ID: I20101027001303 |
| Provider Name | Nadia Ann Czarniak |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1841532165 PECOS PAC ID: 5092174847 Enrollment ID: I20230711003056 |
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