Provider Demographics
NPI:1245802404
Name:CLOSE TO HOME PERSONAL CARE, LLC
Entity Type:Organization
Organization Name:CLOSE TO HOME PERSONAL CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHENISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-306-3263
Mailing Address - Street 1:6051 W BROWN DEER RD STE 203
Mailing Address - Street 2:
Mailing Address - City:BROWN DEER
Mailing Address - State:WI
Mailing Address - Zip Code:53223-2263
Mailing Address - Country:US
Mailing Address - Phone:414-306-3263
Mailing Address - Fax:
Practice Address - Street 1:6051 W BROWN DEER RD STE 203
Practice Address - Street 2:
Practice Address - City:BROWN DEER
Practice Address - State:WI
Practice Address - Zip Code:53223-2263
Practice Address - Country:US
Practice Address - Phone:414-306-3263
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-15
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health