Healthcare Provider Details

I. General information

NPI: 1215645999
Provider Name (Legal Business Name): TOTALLY KIDS CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2022
Last Update Date: 06/09/2025
Certification Date: 06/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5114 N 81ST ST
MILWAUKEE WI
53218-3601
US

IV. Provider business mailing address

5114 N 81ST ST
MILWAUKEE WI
53218-3601
US

V. Phone/Fax

Practice location:
  • Phone: 770-412-2622
  • Fax:
Mailing address:
  • Phone: 470-541-0393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: LATOYA MARIE JONES
Title or Position: ADMINISTRATOR
Credential: OWNER
Phone: 470-541-0393