=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861727075
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CELESTIAL CARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/06/2009
-----------------------------------------------------
Last Update Date | 10/06/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2231 N 119TH ST
-----------------------------------------------------
City | WAUWATOSA
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53226-2015
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-588-7915
-----------------------------------------------------
Fax | 414-453-8425
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2231 N 119TH ST
-----------------------------------------------------
City | WAUWATOSA
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53226-2015
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-588-7915
-----------------------------------------------------
Fax | 414-453-8425
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. LINDA ANN TWELMEYER
-----------------------------------------------------
Credential | LPN
-----------------------------------------------------
Telephone | 414-588-7915
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------