Organization
POTTER'S HOUSE CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEQUANA BOSTICK (MANAGER)
(414) 316-7409
Entity
Organization
Contact information
Practice address
4408 W GARFIELD AVE, MILWAUKEE, WI 53208-1232
(414) 316-7409
Mailing address
4408 WEST GARFIELDAVE, MILWAUKEE, WI 53208
(414) 316-7409
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
—
—
Other
Enumeration date
10/09/2013
Last updated
10/10/2013
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