Organization Name: | SUPPORTIVE PERSONAL CARE SERV ICES |
NPI Number: | 1568898260 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | WANDA F STAPLES (CEO) |
Mailing Address: | 5600 W Brown Deer Rd Suite 103 Brown Deer |
State: | WI US |
Postal Code: | 532232311 |
Phone Number: | 4147510410 |
Fax Number: | |
NPI Enumeration Date: | 09/25/2013 |
NPI Last Update Date: | 05/10/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 253Z00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Agencies |
Taxonomy Classification: | In Home Supportive Care |
Taxonomy Specialization: | |
Taxonomy Definition: | An In Home Supportive Care Agency provides services in the patient |