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General NPI Number Information
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NPI Number | 1982110771
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Entity Type | Organization
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Legal Business Name | WINTERSPRINGS PCA, LLC
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Dates
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Enumeration Date | 12/16/2017
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Last Update Date | 12/16/2017
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Provider Practice Location Address
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Address Line | 7811 W BURLEIGH ST
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City | MILWAUKEE
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State | WI
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Zip | 53222-4914
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Country | US
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Telephone | 414-444-3125
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Fax | 414-873-0632
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Provider Business Mailing Address
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Address Line | 7811 W BURLEIGH ST
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City | MILWAUKEE
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State | WI
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Zip | 53222-4914
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Country | US
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Telephone | 414-444-3125
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Fax | 414-873-0632
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Authorized Official
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Title or Position | OWNER
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Name | SARAH SMITH-PITTMAN
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Credential |
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Telephone | 414-426-2912
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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 | 100069935
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License Number State | WI
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