Healthcare Provider Details

I. General information

NPI: 1336445667
Provider Name (Legal Business Name): PATIENT CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2011
Last Update Date: 02/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4879 N 39 STREET
MILWAUKEE WI
53209
US

IV. Provider business mailing address

4879 N 39 STREET
MILWAUKEE WI
53209
US

V. Phone/Fax

Practice location:
  • Phone: 414-312-8094
  • Fax: 414-226-6578
Mailing address:
  • Phone: 414-312-8094
  • Fax: 414-226-6578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: RUTH MAE FRAIS
Title or Position: CNA
Credential:
Phone: 414-312-8094