MEDICARE: WHITE'S 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	W060837	WI

General Provider Information

NPI Number	:	1346581782
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WHITE'S HOME CARE LLC

Provider Business Mailing Address
First Line	:	6400 W CAPITOL DR
Second Line	:	SUITE 212
City	:	MILWAUKEE
State	:	WI
Zip	:	53216-2156
Country	:	US
Telephone Number	:	414-536-7098
Fax Number	:	414-536-7106

Provider Business Practice Location Address
First Line	:	6400 W CAPITOL DR
Second Line	:	SUITE 212
City	:	MILWAUKEE
State	:	WI
Zip	:	53216-2156
Country	:	US
Telephone Number	:	414-536-7098
Fax Number	:	414-536-7106

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	LANELL WHITE
Credential	:	ICS
Telephone Number	:	414-536-7098

Provider Enumeration Date	:	03/11/2013
Last Update Date	:	03/11/2013

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