Provider Demographics
NPI:1437228244
Name:LS PROFESSIONAL COMFORT HOMES INC
Entity Type:Organization
Organization Name:LS PROFESSIONAL COMFORT HOMES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:STAMM
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:262-781-0448
Mailing Address - Street 1:4765 N 148TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-1566
Mailing Address - Country:US
Mailing Address - Phone:262-781-0448
Mailing Address - Fax:262-781-1307
Practice Address - Street 1:14665 W LISBON RD
Practice Address - Street 2:SUITE 1A
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-1687
Practice Address - Country:US
Practice Address - Phone:262-781-0448
Practice Address - Fax:262-781-1307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1022251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41536900Medicaid
WI41752000Medicaid
WI41536900Medicaid
WI41752000Medicaid