Provider Demographics
NPI:1255830261
Name:ENTITLED PERSONAL CARE, LLC
Entity Type:Organization
Organization Name:ENTITLED PERSONAL CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:TENG
Authorized Official - Last Name:CHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-206-4301
Mailing Address - Street 1:7319 N TEUTONIA AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53209-2005
Mailing Address - Country:US
Mailing Address - Phone:414-206-4301
Mailing Address - Fax:414-206-4302
Practice Address - Street 1:7319 N TEUTONIA AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53209-2005
Practice Address - Country:US
Practice Address - Phone:414-206-4301
Practice Address - Fax:414-206-4302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-05
Last Update Date:2018-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100065593Medicaid