Provider Demographics
NPI:1588190185
Name:LIVING WELL HOME HEALTH CARE & SUPPORTIVE CARE
Entity Type:Organization
Organization Name:LIVING WELL HOME HEALTH CARE & SUPPORTIVE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-231-3710
Mailing Address - Street 1:P.O. BOX 241003
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53224-2633
Mailing Address - Country:US
Mailing Address - Phone:414-231-3710
Mailing Address - Fax:414-231-3734
Practice Address - Street 1:6937 W. FOND DU LAC AVE
Practice Address - Street 2:
Practice Address - City:MIL
Practice Address - State:WI
Practice Address - Zip Code:53218
Practice Address - Country:US
Practice Address - Phone:414-231-3710
Practice Address - Fax:414-231-3734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-03
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1649713033Medicaid
WI100067073Medicaid