Provider Demographics
NPI:1558604744
Name:JEANS NEW CREATION PERSONAL CARE AGENCY
Entity Type:Organization
Organization Name:JEANS NEW CREATION PERSONAL CARE AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CLIMMIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:CNA
Authorized Official - Phone:414-254-8216
Mailing Address - Street 1:6830 W VILLARD AVE
Mailing Address - Street 2:190
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53218-3968
Mailing Address - Country:US
Mailing Address - Phone:414-239-8833
Mailing Address - Fax:414-239-8833
Practice Address - Street 1:6830 W VILLARD AVE
Practice Address - Street 2:190
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53218-3968
Practice Address - Country:US
Practice Address - Phone:414-239-8833
Practice Address - Fax:414-239-8833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-05
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI243369251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI243369OtherCNA