Provider Demographics
NPI:1851092001
Name:THERAPEUTIC HEALING PERSONAL CARE AGENCY LLC
Entity Type:Organization
Organization Name:THERAPEUTIC HEALING PERSONAL CARE AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JOSEPHINE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-433-6055
Mailing Address - Street 1:11431 N PORT WASHINGTON RD STE 211
Mailing Address - Street 2:
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53092-3462
Mailing Address - Country:US
Mailing Address - Phone:414-433-6055
Mailing Address - Fax:414-435-9514
Practice Address - Street 1:11431 N PORT WASHINGTON RD STE 211
Practice Address - Street 2:
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092-3462
Practice Address - Country:US
Practice Address - Phone:414-433-6055
Practice Address - Fax:414-435-9514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-14
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100165867Medicaid