Provider Demographics
NPI:1740915883
Name:ESSENTIAL HOME CARE LIVING, LLC
Entity type:Organization
Organization Name:ESSENTIAL HOME CARE LIVING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAKISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:DILWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:AM
Authorized Official - Phone:262-720-2552
Mailing Address - Street 1:PO BOX 91154
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53209-8154
Mailing Address - Country:US
Mailing Address - Phone:262-720-2552
Mailing Address - Fax:414-755-7404
Practice Address - Street 1:4680 W BRADLEY RD
Practice Address - Street 2:
Practice Address - City:BROWN DEER
Practice Address - State:WI
Practice Address - Zip Code:53223-3764
Practice Address - Country:US
Practice Address - Phone:414-446-8039
Practice Address - Fax:414-755-7405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-22
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Multi-Specialty
No251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100159620Medicaid