Provider Demographics
NPI:1609444785
Name:SOUTH MILWAUKEE WI CAREGIVING LLC
Entity Type:Organization
Organization Name:SOUTH MILWAUKEE WI CAREGIVING LLC
Other - Org Name:CORNERSTONE CAREGIVING LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHANDLER
Authorized Official - Middle Name:
Authorized Official - Last Name:MINER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-400-2625
Mailing Address - Street 1:209 S 28TH ST
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76710-7415
Mailing Address - Country:US
Mailing Address - Phone:254-400-2625
Mailing Address - Fax:
Practice Address - Street 1:9401 W BELOIT RD STE 215
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53227-4357
Practice Address - Country:US
Practice Address - Phone:414-250-0740
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CORNERSTONE CAREGIVING LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-06-15
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care