Healthcare Provider Details

I. General information

NPI: 1336679018
Provider Name (Legal Business Name): BUTTERFLYZ, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2017
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3628 W WRIGHT ST
MILWAUKEE WI
53210-3057
US

IV. Provider business mailing address

6235 N TEUTONIA AVE
MILWAUKEE WI
53209-3648
US

V. Phone/Fax

Practice location:
  • Phone: 414-426-3575
  • Fax:
Mailing address:
  • Phone: 414-426-3575
  • 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 Code177F00000X
TaxonomyLodging Provider
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. BABOONIE TATUM
Title or Position: MANAGER
Credential: BS, M.ED
Phone: 414-915-8189