Provider Demographics
NPI:1255787917
Name:HOME LIVING SERVICES CORP
Entity type:Organization
Organization Name:HOME LIVING SERVICES CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:WILDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-357-4166
Mailing Address - Street 1:3808 W ELM ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53209-3031
Mailing Address - Country:US
Mailing Address - Phone:414-357-4166
Mailing Address - Fax:414-540-1066
Practice Address - Street 1:3808 W ELM ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53209-3031
Practice Address - Country:US
Practice Address - Phone:414-357-4166
Practice Address - Fax:414-540-1066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-11
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health