MEDICARE: SANCTUARY HOME CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1235072133
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SANCTUARY HOME CARE LLC

Provider Business Mailing Address
First Line	:	7800 DISCOVERY DR OFC 328
Second Line	:
City	:	MIDDLETON
State	:	WI
Zip	:	53562-5501
Country	:	US
Telephone Number	:	201-660-0985
Fax Number	:

Provider Business Practice Location Address
First Line	:	7800 DISCOVERY DR OFC 328
Second Line	:
City	:	MIDDLETON
State	:	WI
Zip	:	53562-5501
Country	:	US
Telephone Number	:	201-660-0985
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	YANNICK LOHONDO DJAMBALAMBA
Credential	:
Telephone Number	:	201-660-0985

Provider Enumeration Date	:	04/14/2026
Last Update Date	:	04/14/2026

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