=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821682956
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BEACON OF ROSES CARERS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/01/2021
-----------------------------------------------------
Last Update Date | 03/01/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6913 WAUNAKEE CIR
-----------------------------------------------------
City | MEQUON
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53092-8520
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 262-302-0460
-----------------------------------------------------
Fax | 262-546-5466
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6913 WAUNAKEE CIR
-----------------------------------------------------
City | MEQUON
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53092-8520
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-585-2462
-----------------------------------------------------
Fax | 262-546-5466
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | MISS LOUISA FRIMPONG
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 602-585-2462
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------