Provider Demographics
NPI:1154019479
Name:LOYALTY FOOTPRINTS OF LIFE
Entity type:Organization
Organization Name:LOYALTY FOOTPRINTS OF LIFE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:
Authorized Official - Last Name:VIRGHES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-702-7058
Mailing Address - Street 1:2742 N 34TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53210-2517
Mailing Address - Country:US
Mailing Address - Phone:414-702-7058
Mailing Address - Fax:
Practice Address - Street 1:2742 N 34TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53210-2517
Practice Address - Country:US
Practice Address - Phone:414-702-7058
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-25
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
No174200000XOther Service ProvidersMeals
No253Z00000XAgenciesIn Home Supportive Care
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
No347C00000XTransportation ServicesPrivate Vehicle
No385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child