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General NPI Number Information
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NPI Number | 1912538679
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Entity Type | Organization
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Legal Business Name | PREMIER PERSONAL CARE AGENCY LLC
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Dates
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Enumeration Date | 01/31/2020
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Last Update Date | 01/31/2020
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Provider Practice Location Address
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Address Line | 10520 W BLUEMOUND RD STE 105 SUITE #105
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City | WAUWATOSA
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State | WI
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Zip | 53226-4484
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Country | US
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Telephone | 414-231-3277
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Fax | 414-231-3172
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Provider Business Mailing Address
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Address Line | 10520 W BLUEMOUND RD STE 105 SUITE #105
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City | WAUWATOSA
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State | WI
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Zip | 53226-4484
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Country | US
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Telephone | 414-231-3277
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Fax | 414-231-3172
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Authorized Official
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Title or Position | DIRECTOR
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Name | RACHEAL KALAMA
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Credential | PHD
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Telephone | 414-628-2774
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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 |
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License Number State |
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