SUPPORTING PROVIDER SERVICES (NPI# 1114393527) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114393527 |
| Entity Type | Organization |
| Organization Name | SUPPORTING PROVIDER SERVICES |
| Practice Address |
8330 S Wynona Ct Oak Creek WI 53154-2740 |
| Practice Telephone | 2625271282 |
| Mailing Telephone | 2625271282 |
| Enumeration Date | 2015-08-19 |
| Last Update Date | 2015-08-19 |
| Authorized Official Name | THERESA BUFORD (VOCATIONAL REHABILITATION) |
| Authorized Official Telephone | 2625271282 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 385HR2065X |
Respite Care Specialization: Respite Care, Physical Disabilities, Child |
Respite Care Facility |
| Street Address |
8330 S WYNONA CT |
| City | OAK CREEK |
| State | WI |
| Zip Code | 53154-2740 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235762881 | Imr Oak Creek Opco, LLC | Skilled Nursing Facility | 2700 West Honadel Boulevard, Oak Creek, WI 53154 | 2020-02-21 |
| 1619512605 | Sharon Boushon | Technician | 642 E Pergola Place, Oak Creek, WI 53154 | 2019-11-13 |
| 1255991386 | Jodi Kruszka | Nurse Practitioner | 825 E Manitowoc Avenue, Oak Creek, WI 53154 | 2019-06-20 |
| 1184288896 | Thomas Carl Jonson | Durable Medical Equipment & Medical Supplies | 9036 S Carollton Dr., Oak Creek, WI 53154 | 2019-04-29 |
| 1982127577 | Zainab Saddiq | Optometrist | 8661 S. Howell Ave, 200, Oak Creek, WI 53154 | 2017-07-25 |
| 1649700980 | Froedtert & The Medical College of Wisconsin Community Physicians, Inc | Durable Medical Equipment & Medical Supplies | 7901 South 6th Street, Oak Creek, WI 53154 | 2017-06-19 |
| 1770969578 | Suhani Virparia | Pharmacist | 171 W. Town Square Way, Oak Creek, WI 53154 | 2015-08-04 |
| 1275919144 | Jessica Ford | Social Worker | 8825 South Howell Avenue, Suite 305, Oak Creek, WISCONSIN 53154 | 2015-08-03 |
| 1700269388 | Tarnit Singh Kapoor | Dentist | 8421 Howell Ave, Oak Creek, WI 53154 | 2015-07-01 |
| 1447656350 | Kiersten Kirking | Physical Therapist | 210 W. Raindbow Ridge Dr., 1207, Oak Creek, WI 53154 | 2014-11-05 |
| Find all providers in zip 53154 | ||||
| Taxonomy Code | 385HR2065X |
| Grouping | Respite Care Facility |
| Classification | Respite Care |
| Specialization | Respite Care, Physical Disabilities, Child |
| A facility or distinct part of a facility that providers short term, residential care to children, diagnosed with complex or profound disabilities as respite for the regular caregivers. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578197760 | Michelle Lynn Macdaniels | Respite Care | 37315 Community Rd Unit 12, Bayfield, WI 54814-5088 | 2020-02-26 |
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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.