Provider Demographics
NPI:1932062155
Name:TEE'S DIRECT CARE LLC
Entity type:Organization
Organization Name:TEE'S DIRECT CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DETRA
Authorized Official - Middle Name:EVON
Authorized Official - Last Name:FERGUSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-213-3966
Mailing Address - Street 1:7101 N GREEN BAY AVE STE 7
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53209-2800
Mailing Address - Country:US
Mailing Address - Phone:414-236-5660
Mailing Address - Fax:414-755-7676
Practice Address - Street 1:6755 N 55TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53223-5911
Practice Address - Country:US
Practice Address - Phone:414-393-3006
Practice Address - Fax:414-236-5261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-12-04
Last Update Date:2025-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home