Healthcare Provider Details

I. General information

NPI: 1306029152
Provider Name (Legal Business Name): COMPASSION CARE FOR THE ELDERLY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2007
Last Update Date: 08/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4621 N 66TH ST
MILWAUKEE WI
53218-4821
US

IV. Provider business mailing address

4621 N 66TH STREET
MILWAUKEE WI
53218
US

V. Phone/Fax

Practice location:
  • Phone: 414-466-3372
  • Fax: 414-393-1606
Mailing address:
  • Phone: 414-466-3372
  • Fax: 414-393-1606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number145791-030
License Number StateWI

VIII. Authorized Official

Name: MISS RAMONA DALANE WALKER
Title or Position: RN ADMINISTRATOR
Credential: RN
Phone: 414-466-3372