Provider Demographics
NPI:1528504602
Name:JEFFERSON CREST LLC
Entity type:Organization
Organization Name:JEFFERSON CREST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-688-7272
Mailing Address - Street 1:126 W MINERAL ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53204-1844
Mailing Address - Country:US
Mailing Address - Phone:414-270-1970
Mailing Address - Fax:414-270-1971
Practice Address - Street 1:126 W MINERAL ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53204-1844
Practice Address - Country:US
Practice Address - Phone:414-270-1970
Practice Address - Fax:414-270-1971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-12
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care