Provider Demographics
NPI:1396286639
Name:HALL AND GATES FAMILY HOME LLC
Entity type:Organization
Organization Name:HALL AND GATES FAMILY HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CEREE
Authorized Official - Middle Name:CRYSTAL
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-808-0808
Mailing Address - Street 1:2451 N 40TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53210-3016
Mailing Address - Country:US
Mailing Address - Phone:414-808-0808
Mailing Address - Fax:
Practice Address - Street 1:2451 N 40TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53210-3016
Practice Address - Country:US
Practice Address - Phone:414-808-0808
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-20
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI0016418251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health