Healthcare Provider Details

I. General information

NPI: 1699643767
Provider Name (Legal Business Name): OBA LIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2025
Last Update Date: 10/29/2025
Certification Date: 10/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4616 N SHERMAN BLVD
MILWAUKEE WI
53209-5856
US

IV. Provider business mailing address

9537 HILLSIDE CT
BROWN DEER WI
53223-1361
US

V. Phone/Fax

Practice location:
  • Phone: 262-649-0362
  • Fax:
Mailing address:
  • Phone: 262-649-0362
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: LATRICE BYNUM
Title or Position: OWNER
Credential:
Phone: 262-327-9157