Provider Demographics
NPI:1851064919
Name:FIRST WATCH HOME CARE SERVICES
Entity Type:Organization
Organization Name:FIRST WATCH HOME CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR/ADMINSTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHAMEKKA
Authorized Official - Middle Name:M
Authorized Official - Last Name:ASHFORD
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:262-643-4382
Mailing Address - Street 1:3623 N 57TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53216-2821
Mailing Address - Country:US
Mailing Address - Phone:414-610-4623
Mailing Address - Fax:262-643-4682
Practice Address - Street 1:8512 W LISBON AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53222-3729
Practice Address - Country:US
Practice Address - Phone:262-643-4382
Practice Address - Fax:262-643-4514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-26
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care