# DIVERSIFIED HEALTH AND SUPPORTIVE SERVICES LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1225783913
- **Authorized official:** SHAUNA PETTIS MSN, APRN, AGPCNP-BC (OWNER/SUBADMINISTRATOR)
- **Authorized official phone:** (414) 748-7776

## Contact information

- **Practice address:** 11520 N PORT WASHINGTON RD STE 208, MEQUON, WI 53092-3432
- **Practice address phone:** (414) 651-5954
- **Mailing address:** 2903 N 74TH ST APT 1, MILWAUKEE, WI 53210-1000
- **Mailing address phone:** (414) 651-5954

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251E00000X | Home Health Agency | — | NULL | Yes |

## Other

- **Enumeration date:** 02/21/2022
- **Last updated:** 02/21/2022