Organization
PROFESSIONAL PERSONAL CARE SERVCIES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TWANDA GATES RN (ADMINISTRATOR)
(414) 847-6330
Entity
Organization
Contact information
Practice address
500 W SILVER SPRING DR, SUITE 200, GLENDALE, WI 53217-5051
(414) 847-6331
(414) 435-3152
Mailing address
500 W SILVER SPRING DR, SUITE 200, GLENDALE, WI 53217-5051
(414) 847-6331
(414) 435-3152
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
10043014
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100043014
—
WI
Enumeration date
05/26/2015
Last updated
05/26/2015
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