DESTANI'S CHILD MEDICAL DAY CARE PROVIDER, INC (NPI# 1013275775) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1013275775 |
| Entity Type | Organization |
| Organization Name | DESTANI'S CHILD MEDICAL DAY CARE PROVIDER, INC |
| Practice Address |
3062 N 58th St #1 Milwaukee WI 53210-1545 |
| Practice Telephone | 4142172495 |
| Practice Fax Number | 4144453893 |
| Mailing Telephone | 4142172495 |
| Mailing Fax Number | 4144453893 |
| Enumeration Date | 2012-05-01 |
| Last Update Date | 2012-05-01 |
| Authorized Official Name | MRS. JANICE M GORDEN (ADMINISTRATOR) |
| Authorized Official Telephone | 4142172495 |
| Authorized Official Credential | R.N. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 3140N1450X |
Skilled Nursing Facility Specialization: Nursing Care, Pediatric |
Nursing & Custodial Care Facilities |
| Street Address |
3062 N 58TH ST #1 |
| City | MILWAUKEE |
| State | WI |
| Zip Code | 53210-1545 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013986231 | Janice Maria Gorden | Registered Nurse | 3062 N 58th St, Milwaukee, WI 53210-1545 | 2006-03-17 |
| 1811393366 | Jl Healthcare, LLC | Case Management | 3062 N 58th St, Milwaukee, WI 53210-1545 | 2014-11-11 |
| 1831439264 | Destani's Child Medical Daycare, Inc | Nursing Care | 3062 N 58th St, Suite 200, Milwaukee, WI 53210-1545 | 2013-02-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700499514 | Mckenzie Lisa Lambeck | Non-emergency Medical Transport (VAN) | 3016a N 36th St, Milwaukee, WI 53210 | 2020-08-31 |
| 1922572312 | Walter's Second Chance of Milwaukee, LLC. | In Home Supportive Care | 3043 N. 29th Street, Milwaukee, WI 53210 | 2019-01-18 |
| 1407353469 | Angie F Caballero | Assisted Living Facility | 5918 N 62nd Street, Milwaukee, WI 53210 | 2018-04-06 |
| 1689182636 | Kimberly Casey | Counselor | 5325 W.burleigh, Milwaukee, WI 53210 | 2018-01-11 |
| 1336663640 | Daron Mosby | Counselor | 2643 N 55th St., 2643 N 55th St., Milwaukee, WI 53210 | 2017-07-28 |
| 1881117174 | Advance Home Care, LLC | In Home Supportive Care | 6001 W Center St Ste 98ll, Milwaukee, WI 53210 | 2017-07-19 |
| 1285181735 | Aurora Family Services | Clinic/Center | 3200 W. Highland Blvd, Aurora Family Services, Milwaukee, WI 53210 | 2016-09-01 |
| 1447625264 | Kimberly Beckham | Registered Nurse | 3040 N 40th Street, Milwaukee, WI 53210 | 2015-12-04 |
| 1033595319 | Wisconsin Lutheran Child & Family Service Inc. | Social Worker | 207 North Sherman Blvd, Milwaukee, WI 53210 | 2015-08-10 |
| 1346633112 | Quiana Davis | Licensed Practical Nurse | 2478 North 34th Street, Milwaukee, WI 53210 | 2015-03-18 |
| Find all providers in zip 53210 | ||||
| Taxonomy Code | 3140N1450X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Skilled Nursing Facility |
| Specialization | Nursing Care, Pediatric |
| A nursing care facility designed and staffed for the provision of nursing care and appropriate educational and habilitative/rehabilitative services to children with multiple, complex or profound disabilities that can not be cared for in a less restrictive environment. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154869410 | Jacksonscott2 | Skilled Nursing Facility | 4573 N. 22nd Street, Milwaukee, WI 53209 | 2017-02-07 |
| 1023367612 | Johnnie Mae Simmons | Skilled Nursing Facility | 4560 N. 40th St, Milwaukee, WI 53209 | 2012-08-29 |
| 1356303101 | Jeannette Ponder | Skilled Nursing Facility | 3152 N 24th Pl, Milwaukee, WI 53206-1209 | 2006-04-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720450125 | Independent Nursing | Skilled Nursing Facility | 143 E Pine Hollow Ln Apt 1, Oak Creek, WI 53154-7714 | 2015-10-24 |
| 1528472024 | Colleen L Biller | Skilled Nursing Facility | 1421 S 17th St, Sheboygan, WI 53081-5123 | 2014-06-12 |
| 1154754620 | Private Duty Nursing Service | Skilled Nursing Facility | 1538 Troy Dr Apt 1, Madison, WI 53704-2074 | 2013-08-19 |
| 1629302872 | Ashley Zimdahl | Skilled Nursing Facility | N2364 Sunset Dr, Campbellsport, WI 53010-2038 | 2009-09-21 |
| 1760634729 | Regina Angela Lanza | Skilled Nursing Facility | W193s7842 Overlook Bay Rd # 6d, Muskego, WI 53150-7813 | 2008-10-21 |
| 1881865012 | Lisa Salaway | Skilled Nursing Facility | 510 Cabrillo Ct, Verona, WI 53593-8233 | 2008-03-16 |
| 1538353982 | Wisconsin Medicaid | Skilled Nursing Facility | 1528 Remington Rd, Neenah, WI 54956-1696 | 2007-08-29 |
| 1336340561 | Badgerland Billing LLC | Skilled Nursing Facility | 2632 Smithfield Dr, Fitchburg, WI 53719-1665 | 2007-05-28 |
| 1336109776 | Medicaid | Skilled Nursing Facility | 1125 Geneva Rd, Menasha, WI 54952-1505 | 2006-03-27 |
| 1558912691 | Bedrock Hcs At Greendale LLC | Skilled Nursing Facility | 5404 W Loomis Rd, Greendale, WI 53129-1411 | 2019-09-20 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.