Individual ProviderSamantha Lynn HolmSocial WorkerBehavioral Health & Social Service ProvidersPractice Address5000 W National Ave, Milwaukee, WI 53295-2324(414) 384-2000(414) 871-6122PECOS EnrollmentBased on the most recent information from CMS, provider Samantha Lynn Holm does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 12:57 PM.Profile DetailsProvider ID1285001529Provider TypeIndividualFull NameHolm, Samantha LynnCredentialBAGenderFemaleSole ProprietorNoEnumeration Date8/21/2015Last Updated2/13/2020Contact InformationPractice LocationPractice Address5000 W National Ave, Milwaukee, WI 53295-2324Phone(414) 384-2000FaxUnlisted FaxMailing LocationMailing Address4929 W Fond Du Lac Ave, Milwaukee, WI 53216-2324Phone(414) 871-6122Fax(414) 871-2552Provider TaxonomiesCodeDescriptionLicenseCode104100000XPrimaryDescriptionSocial WorkerBehavioral Health & Social Service ProvidersLicenseUnlisted IssuerCode171M00000XDescriptionCase Manager/Care CoordinatorOther Service ProvidersLicenseUnlisted Issuer