Provider Demographics
NPI:1619376464
Name:MAKING A DIFFERENCE COMMUNITY SERVICES
Entity Type:Organization
Organization Name:MAKING A DIFFERENCE COMMUNITY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/FOUNDER
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:P
Authorized Official - Last Name:HUNTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-344-3691
Mailing Address - Street 1:PO BOX 1264
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53141-1264
Mailing Address - Country:US
Mailing Address - Phone:262-577-5776
Mailing Address - Fax:186-683-4169
Practice Address - Street 1:5902 5TH AVE
Practice Address - Street 2:1
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53140-4221
Practice Address - Country:US
Practice Address - Phone:262-577-5776
Practice Address - Fax:186-683-4169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-18
Last Update Date:2014-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care