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NPI 1053201152

NPI 1053201152 : ERICSTEADFAST PERSONAL CARE AGENCY : MILWAUKEE, WI

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General NPI Number Information
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    NPI Number           |    1053201152
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    Entity Type          |    Organization 
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    Legal Business Name  |    ERICSTEADFAST PERSONAL CARE AGENCY 
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Dates
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    Enumeration Date     |    07/09/2025
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    Last Update Date     |    07/09/2025
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Provider Practice Location Address
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    Address Line         |    3725 N 38TH ST 
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    City                 |    MILWAUKEE
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    State                |    WI
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    Zip                  |    53216-3011
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    Country              |    US
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    Telephone            |    262-993-3748
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    Fax                  |    
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Provider Business Mailing Address
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    Address Line         |    3725 N 38TH ST 
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    City                 |    MILWAUKEE
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    State                |    WI
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    Zip                  |    53216-3011
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    Country              |    US
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    Telephone            |    262-993-3748
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    Fax                  |    
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Authorized Official
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    Title or Position    |    OWNER
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    Name                 |     ROSE  ALEXANDER 
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    Credential           |    
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    Telephone            |    262-993-3748
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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    Taxonomy Code        |    251E00000X
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    Taxonomy Name        |    Home Health Agency
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    License Number       |    
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    License Number State |    
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