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General NPI Number Information
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NPI Number | 1932062155
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Entity Type | Organization
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Legal Business Name | TEE'S DIRECT CARE LLC
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Dates
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Enumeration Date | 12/04/2025
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Last Update Date | 12/04/2025
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Provider Practice Location Address
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Address Line | 6755 N 55TH ST
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City | MILWAUKEE
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State | WI
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Zip | 53223-5911
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Country | US
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Telephone | 414-393-3006
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Fax | 414-236-5261
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Provider Business Mailing Address
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Address Line | 7101 N GREEN BAY AVE STE 7
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City | GLENDALE
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State | WI
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Zip | 53209-2800
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Country | US
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Telephone | 414-236-5660
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Fax | 414-755-7676
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Authorized Official
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Title or Position | CEO
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Name | DETRA EVON FERGUSON
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Credential |
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Telephone | 414-213-3966
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State |
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