Provider Demographics
NPI:1619331162
Name:IN HOME 2 PERSONAL CARE AGENCY LLC
Entity Type:Organization
Organization Name:IN HOME 2 PERSONAL CARE AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHI'LONDA
Authorized Official - Middle Name:D
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-269-9800
Mailing Address - Street 1:4319 N 76TH ST STE 9
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53222-2056
Mailing Address - Country:US
Mailing Address - Phone:414-269-9800
Mailing Address - Fax:
Practice Address - Street 1:4319 N 76TH ST STE 9
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53222-2056
Practice Address - Country:US
Practice Address - Phone:414-269-9800
Practice Address - Fax:414-269-9894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-11
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI26851025OtherCNA