Organization
CENTER OF CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAKEESHA JACKSON RN (ADMINISTRATOR)
(414) 803-8934
Entity
Organization
Contact information
Practice address
7607 W TOWNSEND ST STE 108, MILWAUKEE, WI 53222-3965
(414) 803-8934
(414) 710-5007
Mailing address
7607 W TOWNSEND ST STE 108, MILWAUKEE, WI 53222-3965
(414) 803-8934
(414) 710-5007
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100015877
—
WI
Enumeration date
08/28/2018
Last updated
11/01/2022
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