LIFESOURCE OF NORTH CAROLINA


Address: 3540 S 43rd St, Milwaukee, WI 53220-1502
Phone: 9107429243

LIFESOURCE OF NORTH CAROLINA (NPI# 1871135723) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1871135723
Entity Type Organization
Organization Name LIFESOURCE OF NORTH CAROLINA
Practice Address 3540 S 43rd St
Milwaukee
WI 53220-1502
Mailing Address Po Box 538622
Atlanta
GA 30353-8622
Practice Telephone 9107429243
Practice Fax Number 8887461787
Mailing Telephone 9107429243
Mailing Fax Number 8887461787
Enumeration Date 2019-10-11
Last Update Date 2019-10-14
Authorized Official Name PEGGY BADDOUR (PRESIDENT/OWNER)
Authorized Official Telephone 9105351211
Is Organization Subpart N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
N 103TC0700X Psychologist
Specialization: Clinical
Behavioral Health & Social Service Providers
N 2084P0800X Psychiatry & Neurology
Specialization: Psychiatry
Allopathic & Osteopathic Physicians
N 363A00000X Physician Assistant Physician Assistants & Advanced Practice Nursing Providers
N 363L00000X Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers
Y 1041C0700X Social Worker
Specialization: Clinical
Behavioral Health & Social Service Providers

Other Provider IDs and Locations

NPI Name Taxonomy Address Enumeration
1497378848 Lifesource of North Carolina Psychologist 8315 Zimpel St, New Orleans, LA 70118-1169 2020-05-20
1649877762 Lifesource of North Carolina Psychologist 501 2nd St, Menominee, MI 49858-3203 2020-10-01
1972131308 Lifesource of North Carolina Psychologist 140 Park Ave, Bloomfield, CT 06002-3207 2020-03-31
1619515277 Lifesource of North Carolina Psychologist 204 W Main St, New London, OH 44851-1070 2019-12-13
1801431127 Lifesource of North Carolina Psychologist 725 2nd Ave S, Hopkins, MN 55343-7782 2019-11-11
1174168496 Lifesource of North Carolina Psychologist 600 Main St S, Minot, ND 58701-4499 2019-11-11
1801431440 Lifesource of North Carolina Psychologist 1728 W 8th St, Cedar Falls, IA 50613-2002 2019-11-07
1093350647 Lifesource of North Carolina Psychologist 2900 W E St, North Platte, NE 69101-1803 2019-11-07
1538728183 Lifesource of North Carolina Psychologist 200 Nursing Home Ln, Pikeville, KY 41501-6896 2019-06-07
1730648288 Lifesource of North Carolina Social Worker 5530 Northrop Rd, Milton, FL 32570-8701 2019-03-14

Other Data Sources

Entity Type Entity Name Entity Address
Virginia Business Entities LifeSource of North Carolina Inc. 5617 Maxwell Place, Wilmington, North Carolina 28408
Alabama Business Registrations LifeSource of North Carolina, Inc. 5617 Maxwell Place, Wilmington, NC 28409

Office Location

Street Address 3540 S 43RD ST
City MILWAUKEE
State WI
Zip Code 53220-1502

Providers in the same location

NPI Name Taxonomy Address Enumeration
1649312000 Rachel Ruthann Burton Occupational Therapist 3540 S 43rd St, Milwaukee, WI 53220-1502 2007-02-13
1205487444 Shane David Frasher Occupational Therapy Assistant 3540 S 43rd St, Milwaukee, WI 53220-1502 2019-09-27
1710538640 Kathleen Ann Shields Physical Therapist 3540 S 43rd St, Milwaukee, WI 53220-1502 2019-09-23
1487172276 Nsh Sunrise LLC Skilled Nursing Facility 3540 S 43rd St, Milwaukee, WI 53220-1502 2017-09-01
1205202959 Jordan Marsh Occupational Therapy Assistant 3540 S 43rd St, Milwaukee, WI 53220-1502 2015-08-18
1346639143 Fmg South 43rd Street Wisconsin LLC Skilled Nursing Facility 3540 S 43rd St, Milwaukee, WI 53220-1502 2015-01-16
1518201573 Jamie Nicole Scott Physical Therapy Assistant 3540 S 43rd St, Milwaukee, WI 53220-1502 2012-11-15
1841554318 Emily Igl Speech-Language Pathologist 3540 S 43rd St, Milwaukee, WI 53220-1502 2012-06-29
1093078859 Tammy Peterson Physical Therapy Assistant 3540 S 43rd St, Milwaukee, WI 53220-1502 2012-06-18
1659669349 Jenna N Maliszewski Skilled Nursing Facility 3540 S 43rd St, Milwaukee, WI 53220-1502 2011-07-14
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Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1871061069 Kathleen Elizabeth White Orthotist 6790 W. Layton Ave, Greenfield, WI 53220 2018-11-06
1992284087 Froedtert & The Medical College of Wisconsin Community Physicians Non-Pharmacy Dispensing Site 4859 South 60th Street, Greenfield, WI 53220 2018-08-09
1609394220 Aaron Park Speech-Language Pathologist 3540 S. 43rd St., Milwaukee, WI 53220 2017-09-04
1730601675 Rosaana Avila Physical Therapist 3944 S. 60th St., Milwaukee, WI 53220 2017-07-12
1285002667 Casey E Reis Nurse Practitioner 4848 S. 76th Street, Greenfield, WI 53220 2015-09-02
1437539798 Luke Robert Garceau Physical Therapist 6520 W. Layton Ave #101, Greenfield, WI 53220 2015-06-02
1295139012 Tammy Giannopoulos, LLC Clinic/Center 4402 S 68th St Suite 100, Greenfield, WI 53220 2014-10-22
1861754244 Lakeshore Medical Clinic Occupational Therapist 4444 West Loomis Road, 200, Greenfield, WI 53220 2012-06-12
1598083115 Rebecca Anne Kappes Licensed Practical Nurse 8208 W Tripoli, Milwaukee, WI 53220 2010-05-06
1699941005 Susan Marie Delaet Physical Therapy Assistant 5700 West Layton Ave, Greenfield, WI 53220 2008-05-06
Find all providers in zip 53220

Taxonomy Information

Taxonomy Code 1041C0700X
Grouping Behavioral Health & Social Service Providers
Classification Social Worker
Specialization Clinical

Taxonomy Definition

A social worker who holds a master’s or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master’s supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances.
Notes: Source: National Association of Social Workers, 2008 [7/1/2009: definition modified]

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1912506908 Compassionate Clinical Services, LLC Social Worker 1314 S 1st St # 210, Milwaukee, WI 53204-2405 2020-10-20
1659986560 Association of Community Empowerment, LLC Social Worker 3500 N Sherman Blvd Ste 303, Milwaukee, WI 53216-3463 2020-09-09
1316550205 Ellice Plant Social Worker 2643 N Newhall St, Milwaukee, WI 53211-3517 2020-08-28
1801407895 Maxine Fran Rabinowe Social Worker 1943 N Summit Ave Apt 14, Milwaukee, WI 53202-1386 2020-08-12
1255953527 Susan C. Donnelly Social Worker 191 N Broadway Unit 205, Milwaukee, WI 53202-6031 2020-05-10
1013556885 Shalonda Renee Leflore Social Worker 3244 N 48th St, Milwaukee, WI 53216-3344 2019-12-27
1003458068 Anaddia S Clark Social Worker 4929 W Fond Du Lac Aveune, Milwaukee, WI 53216-2324 2019-10-11
1639727258 Lauren Marie Kubik Social Worker 2375 N 67th St, Milwaukee, WI 53213-1438 2019-08-27
1164077319 Casey Mccarragher Social Worker 3330 W Wells St, Milwaukee, WI 53208-3333 2019-08-05
1023661659 Edwin Bacalso Social Worker 2524 E Webster Pl Ste 203, Milwaukee, WI 53211-4257 2019-07-23
Find all providers in MILWAUKEE

Competitor

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City MILWAUKEE
Zip Code 53220

Improve Information

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Dataset Information

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.

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