Healthcare Provider Details

I. General information

NPI: 1922769025
Provider Name (Legal Business Name): BEHIND THE SCENES STAFFING AGENCY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2022
Last Update Date: 01/02/2022
Certification Date: 01/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4118 W CAPITOL DR
MILWAUKEE WI
53216-2533
US

IV. Provider business mailing address

4118 W CAPITOL DR
MILWAUKEE WI
53216-2533
US

V. Phone/Fax

Practice location:
  • Phone: 414-377-1738
  • Fax:
Mailing address:
  • Phone: 414-377-1738
  • 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 Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. EBONY K WALKER
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 414-377-1738