Provider Demographics
NPI:1336679018
Name:BUTTERFLYZ, LLC
Entity Type:Organization
Organization Name:BUTTERFLYZ, LLC
Other - Org Name:OMNI TRANSITIONAL SUPPORTIVE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:BABOONIE
Authorized Official - Middle Name:
Authorized Official - Last Name:TATUM
Authorized Official - Suffix:
Authorized Official - Credentials:BS, MED
Authorized Official - Phone:414-915-8189
Mailing Address - Street 1:6235 N TEUTONIA AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53209-3648
Mailing Address - Country:US
Mailing Address - Phone:414-426-3575
Mailing Address - Fax:
Practice Address - Street 1:3628 W WRIGHT ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53210-3057
Practice Address - Country:US
Practice Address - Phone:414-426-3575
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BUTTERFLYZ, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-06-15
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No177F00000XOther Service ProvidersLodging
No253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty