Provider Demographics
NPI:1689112302
Name:ENLIGHTEN PERSONAL CARE AGENCY
Entity Type:Organization
Organization Name:ENLIGHTEN PERSONAL CARE AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LEOLA
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CSAC, LPC-IT
Authorized Official - Phone:414-248-7533
Mailing Address - Street 1:3565 N MARTIN LUTHER KING DR
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53212-1459
Mailing Address - Country:US
Mailing Address - Phone:414-248-7533
Mailing Address - Fax:414-444-8432
Practice Address - Street 1:3565 N MARTIN LUTHER KING DR
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53212-1459
Practice Address - Country:US
Practice Address - Phone:414-248-7533
Practice Address - Fax:414-444-8432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-01
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health