Abby's Clubhouse / Abby Boo Inc

Primary specialty

Early Intervention Provider AgencyTaxonomy code 252Y00000X

Legal business name

ABBY'S CLUBHOUSE / ABBY BOO INC

Doing business as

Abby's Clubhouse

Practice address

2640 W Fondulac Ave
Milwaukee, WI 53206

Phone

(414) 514-3651

NPI assigned

Apr 27, 2020

Last updated

Feb 5, 2021By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Caprice Mathies

Title

Owner

Phone

(414) 242-1174

Specialties & licenses 5

Addresses

Other names 2

• Abby's Clubhouse Doing business as
• MTC Business Former legal business name

Electronic endpoints 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1587945600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1612483200000",
    "number": "1114548542",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1052",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532011052"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2640 W FONDULAC AVE",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "53206",
            "telephone_number": "414-514-3651"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ABBY'S CLUBHOUSE / ABBY BOO INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-04-27",
        "last_updated": "2021-02-05",
        "certification_date": "2021-02-05",
        "status": "A",
        "authorized_official_last_name": "MATHIES",
        "authorized_official_first_name": "CAPRICE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "414-242-1174"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "251J00000X",
            "taxonomy_group": "",
            "desc": "Nursing Care",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "251K00000X",
            "taxonomy_group": "",
            "desc": "Public Health or Welfare",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "252Y00000X",
            "taxonomy_group": "",
            "desc": "Early Intervention Provider Agency",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "ch@mtcbusinesscm.com",
            "affiliation": "N",
            "endpointDescription": "business email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "2640 W Fondulac Ave",
            "city": "Milwaukee",
            "state": "WI",
            "country_code": "US",
            "postal_code": "53206",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Abby's Clubhouse",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "MTC Business",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Shervin Abbasi
• Ashley Abbott-Quam, RN
• Abby Personal Care Inc. (Abby Personal Care)
• Abc Supportive Living LLC
• Abcw Home Health Care Agency,LLC
• Abubaker Abdalla, MD
• Amir Abdelli, MD
• Ahmed Abdelmagid, M.D.

• Early Intervention Provider Agency in Milwaukee, WI
• Providers in Milwaukee, WI by specialty
• Early Intervention Provider Agency in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.