Provider Demographics
NPI:1831675578
Name:EMINENT LIFECARE SOLUTIONS
Entity Type:Organization
Organization Name:EMINENT LIFECARE SOLUTIONS
Other - Org Name:N/A
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:WALUSAYI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-520-1977
Mailing Address - Street 1:4922 N 85TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53225-4209
Mailing Address - Country:US
Mailing Address - Phone:414-520-1977
Mailing Address - Fax:
Practice Address - Street 1:4922 N 85TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53225-4209
Practice Address - Country:US
Practice Address - Phone:414-520-1977
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-16
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care