Provider Demographics
NPI:1851749675
Name:ATTENTIVE HOME CARE, INC
Entity Type:Organization
Organization Name:ATTENTIVE HOME CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SERVICES DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-444-4003
Mailing Address - Street 1:10721 W CAPITOL DR
Mailing Address - Street 2:SUITE 224
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53222-1210
Mailing Address - Country:US
Mailing Address - Phone:414-897-0834
Mailing Address - Fax:414-897-0839
Practice Address - Street 1:10721 W CAPITOL DR
Practice Address - Street 2:SUITE 224
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53222-1210
Practice Address - Country:US
Practice Address - Phone:414-444-4003
Practice Address - Fax:414-444-5003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-02
Last Update Date:2017-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI100037380253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100037380Medicaid