=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821863614
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TAKE CONTROL HEALTH SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/21/2023
-----------------------------------------------------
Last Update Date | 11/21/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 756 N 35TH ST STE 201
-----------------------------------------------------
City | MILWAUKEE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53208-3360
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-293-2595
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5474 N 26TH ST
-----------------------------------------------------
City | GLENDALE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53209-4931
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-326-6930
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO/OWNER
-----------------------------------------------------
Name | MRS. RUBY LATOSHA MCCAIN
-----------------------------------------------------
Credential | NP
-----------------------------------------------------
Telephone | 414-293-2595
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------