Healthcare Provider Details

I. General information

NPI: 1043136740
Provider Name (Legal Business Name): RESTORATIVE ROOTS HOME HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7477 N 86TH ST
MILWAUKEE WI
53224-4051
US

IV. Provider business mailing address

7477 N 86TH ST
MILWAUKEE WI
53224-4051
US

V. Phone/Fax

Practice location:
  • Phone: 414-334-9452
  • Fax: 414-334-9452
Mailing address:
  • Phone: 414-334-9452
  • Fax: 414-334-9452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. AMBER WILLIS
Title or Position: ADMINISTRATOR
Credential: DBA
Phone: 414-334-9452