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General NPI Number Information
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NPI Number | 1619376464
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Entity Type | Organization
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Legal Business Name | MAKING A DIFFERENCE COMMUNITY SERVICES
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Dates
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Enumeration Date | 08/18/2014
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Last Update Date | 12/21/2014
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Provider Practice Location Address
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Address Line | 5902 5TH AVE 1
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City | KENOSHA
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State | WI
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Zip | 53140-4221
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Country | US
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Telephone | 262-577-5776
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Fax | 186-683-4169
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Provider Business Mailing Address
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Address Line | PO BOX 1264
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City | KENOSHA
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State | WI
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Zip | 53141-1264
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Country | US
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Telephone | 262-577-5776
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Fax | 186-683-4169
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Authorized Official
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Title or Position | CEO/FOUNDER
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Name | MS. LISA P HUNTER
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Credential |
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Telephone | 262-344-3691
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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