Healthcare Provider Details

I. General information

NPI: 1801492392
Provider Name (Legal Business Name): LIQUID GIGS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2020
Last Update Date: 12/09/2020
Certification Date: 12/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8383 GREENWAY BLVD STE 600
MIDDLETON WI
53562-4659
US

IV. Provider business mailing address

8383 GREENWAY BLVD STE 600
MIDDLETON WI
53562-4659
US

V. Phone/Fax

Practice location:
  • Phone: 608-982-0304
  • Fax:
Mailing address:
  • Phone: 608-982-0304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. JEFFERSON STANLEY
Title or Position: PRESIDENT
Credential:
Phone: 608-982-0304