Healthcare Provider Details

I. General information

NPI: 1467281667
Provider Name (Legal Business Name): ROBERT LEE AT EASE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2024
Last Update Date: 01/11/2025
Certification Date: 01/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 N SHERMAN BLVD STE 305A
MILWAUKEE WI
53216-3463
US

IV. Provider business mailing address

3500 N SHERMAN BLVD STE 305A
MILWAUKEE WI
53216-3463
US

V. Phone/Fax

Practice location:
  • Phone: 414-455-7471
  • Fax: 207-419-7426
Mailing address:
  • Phone: 414-455-7471
  • Fax: 207-419-7426

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: MRS. LATOYA MONIQUE SPENCER
Title or Position: OWNER
Credential: A.A.S.
Phone: 470-880-7858