=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336143395
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INDEPENDENCEFIRST
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/08/2005
-----------------------------------------------------
Last Update Date | 04/24/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 540 S 1ST ST
-----------------------------------------------------
City | MILWAUKEE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53204-1605
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-291-7520
-----------------------------------------------------
Fax | 414-291-7525
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 540 S 1ST ST
-----------------------------------------------------
City | MILWAUKEE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53204-1605
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-291-7520
-----------------------------------------------------
Fax | 414-291-7525
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | COO
-----------------------------------------------------
Name | MRS. DEB LANGHAM
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 414-226-8371
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 43104200
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------