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General NPI Number Information
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NPI Number | 1598140055
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Entity Type | Organization
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Legal Business Name | LIFE AND LIBERTY HOME HEALTHCARE, LLC
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Dates
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Enumeration Date | 07/27/2015
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Last Update Date | 07/27/2015
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Provider Practice Location Address
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Address Line | 756 N 35TH ST SUITE 205
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City | MILWAUKEE
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State | WI
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Zip | 53208-3360
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Country | US
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Telephone | 414-345-1111
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Fax | 414-755-7337
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Provider Business Mailing Address
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Address Line | 756 N 35TH ST SUITE 205
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City | MILWAUKEE
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State | WI
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Zip | 53208-3360
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Country | US
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Telephone | 414-345-1111
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Fax | 414-755-7337
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. TYWANA GEORGE
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Credential |
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Telephone | 414-345-1111
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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 | 100045501
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License Number State | WI
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