Provider Demographics
NPI:1811653405
Name:STA HOME HEALTHCARE LLC.
Entity type:Organization
Organization Name:STA HOME HEALTHCARE LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TODTIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-722-7100
Mailing Address - Street 1:7430 HARWOOD AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53213-2641
Mailing Address - Country:US
Mailing Address - Phone:414-722-7100
Mailing Address - Fax:
Practice Address - Street 1:7430 HARWOOD AVE STE 150
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53213-2641
Practice Address - Country:US
Practice Address - Phone:414-722-7100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-09
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care