Healthcare Provider Details

I. General information

NPI: 1609445022
Provider Name (Legal Business Name): RELIANCE PERSONAL CARE AGENCY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2021
Last Update Date: 04/28/2025
Certification Date: 04/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10721 W CAPITOL DR STE 211
WAUWATOSA WI
53222-1210
US

IV. Provider business mailing address

N65W12552 MARACH RD
MENOMONEE FALLS WI
53051-8325
US

V. Phone/Fax

Practice location:
  • Phone: 414-455-3033
  • Fax: 414-677-7233
Mailing address:
  • Phone: 414-377-3225
  • Fax:

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 Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: FRANCIS KOJO BUOR
Title or Position: PRESIDENT
Credential:
Phone: 414-455-3033