NPIMap

Organization Active NPI

Life Enhancement Supportive Services

  • Case Manager/Care Coordinator
  • Milwaukee, WI
National Provider Identifier
1184060998
Registry record updated May 20, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Case Manager/Care CoordinatorTaxonomy code 171M00000X
Legal business name
LIFE ENHANCEMENT SUPPORTIVE SERVICES
Practice address
3537 N 57TH St
Milwaukee, WI 53216-2819
Phone
(414) 690-0672
NPI assigned
May 20, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 20, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Tonyetta L Ross, BS, SACITNPI 1003132473
Title
Executive Director
Phone
(414) 690-0672

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Case Manager/Care CoordinatorGroup: 193400000X SINGLE SPECIALTY GROUP 171M00000X Primary

Addresses

Primary practice location

3537 N 57TH St
Milwaukee, WI 53216-2819

Mailing address

3537 N 57TH St
Milwaukee, WI 53216-2819
Phone (414) 690-0672

Other identifiers 1

IdentifierTypeStateIssuer
12088599OtherWICAQH

National Provider Directory

National Provider Directory
Tax ID family
Life Enhancement Supportive Services2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1369008000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1369008000000",
    "number": "1184060998",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3537 N 57TH ST",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532162819",
            "telephone_number": "414-690-0672"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3537 N 57TH ST",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532162819",
            "telephone_number": "414-690-0672"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFE ENHANCEMENT SUPPORTIVE SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-05-20",
        "last_updated": "2013-05-20",
        "status": "A",
        "authorized_official_last_name": "ROSS",
        "authorized_official_first_name": "TONYETTA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "414-690-0672",
        "authorized_official_credential": "BS, SACIT"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "12088599",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Milwaukee, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.