Healthcare Provider Details

I. General information

NPI: 1891154704
Provider Name (Legal Business Name): GREENSPAN HOME HEALTH CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2016
Last Update Date: 12/06/2022
Certification Date: 12/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3521 W NATIONAL AVE
MILWAUKEE WI
53215-1024
US

IV. Provider business mailing address

3521 W NATIONAL AVE
MILWAUKEE WI
53215-1024
US

V. Phone/Fax

Practice location:
  • Phone: 414-763-6000
  • Fax: 414-763-6150
Mailing address:
  • Phone: 414-763-6000
  • Fax: 414-763-6150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number100042075
License Number StateWI
# 5
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: NINA YATES
Title or Position: ADMINISTRATOR
Credential:
Phone: 414-763-6000