=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114812088
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOME SWEET HOME SUPPORTIVE HOME CARE AGENCY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/11/2025
-----------------------------------------------------
Last Update Date | 06/13/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3475 N BUSFUM STREET
-----------------------------------------------------
City | MILWAUKEE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53212
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-501-3034
-----------------------------------------------------
Fax | 414-501-3034
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 500 W SILVER SPRING DR STE K200
-----------------------------------------------------
City | GLENDALE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53217-5052
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-501-3034
-----------------------------------------------------
Fax | 414-501-3034
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MS. SAKOTA DAWN TRIPLETT
-----------------------------------------------------
Credential | PROVIDER
-----------------------------------------------------
Telephone | 414-469-7658
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------