Organization
HOLMES PERSONAL CARE AGENCY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEREK J HOLMES (OWNER)
(141) 207-1852
Entity
Organization
Contact information
Practice address
10111 W CAPITOL DR STE 8, WAUWATOSA, WI 53222-1335
(414) 207-1852
(414) 444-7896
Mailing address
10111 W CAPITOL DR STE 8, WAUWATOSA, WI 53222-1335
(414) 207-1852
(414) 444-7896
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100102242
—
WI
Enumeration date
10/19/2020
Last updated
10/19/2020
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