Healthcare Provider Details

I. General information

NPI: 1740193903
Provider Name (Legal Business Name): BRILLIANTAIRES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2902 S DELAWARE AVE
MILWAUKEE WI
53207-2517
US

IV. Provider business mailing address

2902 S DELAWARE AVE
MILWAUKEE WI
53207-2517
US

V. Phone/Fax

Practice location:
  • Phone: 414-317-3014
  • Fax:
Mailing address:
  • Phone: 414-317-3014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ROBERTA STEWARD
Title or Position: CEO FOUNDER
Credential:
Phone: 414-317-3014