Provider Demographics
NPI:1568105328
Name:CROOM PRIVATE CARE LLC
Entity Type:Organization
Organization Name:CROOM PRIVATE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:NELL
Authorized Official - Last Name:CROOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-339-1261
Mailing Address - Street 1:3744 N. 42ND STREET
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53216
Mailing Address - Country:US
Mailing Address - Phone:414-339-1261
Mailing Address - Fax:414-988-4930
Practice Address - Street 1:3744 N. 42ND STREET
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53216
Practice Address - Country:US
Practice Address - Phone:414-339-1261
Practice Address - Fax:414-988-4930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-19
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1463Medicaid