Provider Demographics
NPI:1801492392
Name:LIQUID GIGS
Entity type:Organization
Organization Name:LIQUID GIGS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFERSON
Authorized Official - Middle Name:
Authorized Official - Last Name:STANLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-982-0304
Mailing Address - Street 1:8383 GREENWAY BLVD STE 600
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-4659
Mailing Address - Country:US
Mailing Address - Phone:608-982-0304
Mailing Address - Fax:
Practice Address - Street 1:8383 GREENWAY BLVD STE 600
Practice Address - Street 2:
Practice Address - City:MIDDLETON
Practice Address - State:WI
Practice Address - Zip Code:53562-4659
Practice Address - Country:US
Practice Address - Phone:608-982-0304
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-09
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No253Z00000XAgenciesIn Home Supportive Care