Provider Demographics
NPI: | 1518736610 |
---|---|
Name: | SILVER SQUARE HEIGHTS HOME CARE |
Entity Type: | Organization |
Organization Name: | SILVER SQUARE HEIGHTS HOME CARE |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PRESIDENT OF OPERATIONS |
Authorized Official - Prefix: | |
Authorized Official - First Name: | MAURICE |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | WEAVER |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 414-499-9270 |
Mailing Address - Street 1: | 5530 N 92ND ST APT 1 |
Mailing Address - Street 2: | |
Mailing Address - City: | MILWAUKEE |
Mailing Address - State: | WI |
Mailing Address - Zip Code: | 53225-3461 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 414-499-9270 |
Mailing Address - Fax: | 888-864-2725 |
Practice Address - Street 1: | 5530 N 92ND ST APT 1 |
Practice Address - Street 2: | |
Practice Address - City: | MILWAUKEE |
Practice Address - State: | WI |
Practice Address - Zip Code: | 53225-3461 |
Practice Address - Country: | US |
Practice Address - Phone: | 414-499-9270 |
Practice Address - Fax: | 888-864-2725 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | HEIGHTS CORPORATION |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2023-12-29 |
Last Update Date: | 2023-12-29 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 310400000X | Nursing & Custodial Care Facilities | Assisted Living Facility | ||
No | 251T00000X | Agencies | Program of All-Inclusive Care for the Elderly (PACE) Provider Organization | ||
No | 3104A0625X | Nursing & Custodial Care Facilities | Assisted Living Facility | Assisted Living, Mental Illness | |
No | 3104A0630X | Nursing & Custodial Care Facilities | Assisted Living Facility | Assisted Living, Behavioral Disturbances | |
No | 320600000X | Residential Treatment Facilities | Residential Treatment Facility, Intellectual and/or Developmental Disabilities | ||
No | 320700000X | Residential Treatment Facilities | Residential Treatment Facility, Physical Disabilities | ||
No | 324500000X | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility | Group - Multi-Specialty | |
No | 373H00000X | Nursing Service Related Providers | Day Training/Habilitation Specialist | Group - Multi-Specialty |