Provider Demographics
NPI:1942579222
Name:BYRD'S PERSONAL CARE AGENCY
Entity Type:Organization
Organization Name:BYRD'S PERSONAL CARE AGENCY
Other - Org Name:BYRD'S PERSONAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:GERTRUDE
Authorized Official - Middle Name:
Authorized Official - Last Name:BYRD
Authorized Official - Suffix:
Authorized Official - Credentials:CNA/ IN HOME SUPPORT
Authorized Official - Phone:414-517-5990
Mailing Address - Street 1:6233 W BOEHLKE AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53223-5410
Mailing Address - Country:US
Mailing Address - Phone:414-517-5990
Mailing Address - Fax:414-236-5314
Practice Address - Street 1:6233 W BOEHLKE AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53223-5410
Practice Address - Country:US
Practice Address - Phone:414-517-5990
Practice Address - Fax:414-236-5314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-15
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI325126253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care