Provider Demographics
NPI:1598218562
Name:RILEY'S RESIDENTIAL HOME CARE, LLC
Entity Type:Organization
Organization Name:RILEY'S RESIDENTIAL HOME CARE, LLC
Other - Org Name:RILEY'S PERSONAL CARE AGENCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/HR MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ALANA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHERARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-429-4694
Mailing Address - Street 1:10111 W CAPITOL DR STE 7
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53222-1335
Mailing Address - Country:US
Mailing Address - Phone:414-429-4694
Mailing Address - Fax:877-421-9343
Practice Address - Street 1:10111 W. CAPITOL DR
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53222
Practice Address - Country:US
Practice Address - Phone:414-429-4694
Practice Address - Fax:877-421-9343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-26
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI100053643253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100053643Medicaid