Individual
RICKEY ROACH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2928 N 55TH ST, MILWAUKEE, WI 53210-1561
(414) 766-8072
Mailing address
PO BOX 241003, MILWAUKEE, WI 53224-9025
(414) 766-8072
(414) 231-3734
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
0019066
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
87-1298668
—
WI
Enumeration date
11/29/2022
Last updated
11/29/2022
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