Provider Demographics
NPI:1679907828
Name:LIFE TOUCHES HOME HEALTHCARE, LLC
Entity Type:Organization
Organization Name:LIFE TOUCHES HOME HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TYWANA
Authorized Official - Middle Name:
Authorized Official - Last Name:GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-465-5433
Mailing Address - Street 1:4234 N 76TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53222-2002
Mailing Address - Country:US
Mailing Address - Phone:414-465-5433
Mailing Address - Fax:866-255-6996
Practice Address - Street 1:4234 N 76TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53222-2002
Practice Address - Country:US
Practice Address - Phone:414-465-5433
Practice Address - Fax:866-255-6996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-23
Last Update Date:2013-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100027746Medicaid