Provider Demographics
NPI:1427758614
Name:NEW PHASE PERSONAL CARE AGENCY LLC
Entity type:Organization
Organization Name:NEW PHASE PERSONAL CARE AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:TURENNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-794-6525
Mailing Address - Street 1:790 N MILWAUKEE ST STE 310
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-4148
Mailing Address - Country:US
Mailing Address - Phone:262-794-6525
Mailing Address - Fax:
Practice Address - Street 1:790 N MILWAUKEE ST STE 310
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-4148
Practice Address - Country:US
Practice Address - Phone:262-794-6525
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-06
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100228332Medicaid