Provider Demographics
NPI:1710351135
Name:ABLE PERSONAL CARE, INC.
Entity Type:Organization
Organization Name:ABLE PERSONAL CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:IVELISSE
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-930-0571
Mailing Address - Street 1:PO BOX 210981
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53221-8017
Mailing Address - Country:US
Mailing Address - Phone:414-930-0571
Mailing Address - Fax:414-930-9017
Practice Address - Street 1:3030 W GRANGE AVE
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53221-3301
Practice Address - Country:US
Practice Address - Phone:414-930-0571
Practice Address - Fax:414-930-9017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-23
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100044530Medicaid