Provider Demographics
NPI:1609195239
Name:EASY LIVING HOME HEALTH CARE AGENCY, INC.
Entity Type:Organization
Organization Name:EASY LIVING HOME HEALTH CARE AGENCY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:BALCERAK
Authorized Official - Suffix:
Authorized Official - Credentials:COTA
Authorized Official - Phone:262-293-3951
Mailing Address - Street 1:W175N11117 STONEWOOD DR STE 100
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53022-6505
Mailing Address - Country:US
Mailing Address - Phone:262-293-3951
Mailing Address - Fax:262-345-5162
Practice Address - Street 1:W175N11117 STONEWOOD DR STE 100
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:WI
Practice Address - Zip Code:53022-6505
Practice Address - Country:US
Practice Address - Phone:262-293-3951
Practice Address - Fax:262-345-5162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-21
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI52-7313OtherPTAN