Direct Care Supportive Service LLC

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

Legal business name

DIRECT CARE SUPPORTIVE SERVICE LLC

Practice address

11805 W Hampton Ave Ste 103C
Milwaukee, WI 53225-3612

Phone

(414) 213-3966

Fax

(414) 755-7676

NPI assigned

Jul 19, 2018

Organization subpart

No

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

Authorized official

Name

Detra Ferguson-Callahan

Title

Owner/Admin

Phone

(414) 213-3966

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1531958400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1531958400000",
    "number": "1861978181",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11805 W HAMPTON AVE STE 103C",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532253612",
            "telephone_number": "414-213-3966",
            "fax_number": "414-755-7676"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11805 W HAMPTON AVE STE 103C",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532253612",
            "telephone_number": "414-213-3966",
            "fax_number": "414-755-7676"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIRECT CARE SUPPORTIVE SERVICE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-07-19",
        "last_updated": "2018-07-19",
        "status": "A",
        "authorized_official_last_name": "FERGUSON-CALLAHAN",
        "authorized_official_first_name": "DETRA",
        "authorized_official_title_or_position": "OWNER/ADMIN",
        "authorized_official_telephone_number": "414-213-3966"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Home Health Agency in Milwaukee, WI
• Providers in Milwaukee, WI by specialty
• Home Health Agency in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2018; 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.