Healthcare Provider Details

I. General information

NPI: 1891602355
Provider Name (Legal Business Name): VITAL CARE COMFORT HOME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

N51W14111 LANCASTER AVE
MENOMONEE FALLS WI
53051-6914
US

IV. Provider business mailing address

N51W14111 LANCASTER AVE
MENOMONEE FALLS WI
53051-6914
US

V. Phone/Fax

Practice location:
  • Phone: 414-477-6955
  • Fax: 262-924-0550
Mailing address:
  • Phone:
  • Fax: 262-924-0550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name: JANAE SIMMONS-TILLMAN
Title or Position: OWNER
Credential: RN
Phone: 414-477-6955