Healthcare Provider Details

I. General information

NPI: 1609580984
Provider Name (Legal Business Name): LIFTING OUR NEIGHBORHOOD NOW COMMUNITY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2023
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4848 S 76TH ST STE 110
GREENFIELD WI
53220-4361
US

IV. Provider business mailing address

4848 S 76TH ST STE 110
GREENFIELD WI
53220-4361
US

V. Phone/Fax

Practice location:
  • Phone: 414-630-6638
  • Fax:
Mailing address:
  • Phone: 414-630-6638
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: NEA D ELLIS
Title or Position: ADMINISTRATOR
Credential: BSN, RN
Phone: 414-630-6638