Healthcare Provider Details

I. General information

NPI: 1861920324
Provider Name (Legal Business Name): TAYYBAT PERSONAL CARE SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2017
Last Update Date: 05/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

342 N WATER ST STE 600
MILWAUKEE WI
53202-5715
US

IV. Provider business mailing address

6505 W CENTER ST APT 2
MILWAUKEE WI
53210-1371
US

V. Phone/Fax

Practice location:
  • Phone: 414-366-4514
  • Fax:
Mailing address:
  • Phone: 414-366-4514
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. KRASHANDA CLEVELAND
Title or Position: CFO/ADMINISTRATOR
Credential:
Phone: 414-366-4514