MEDICARE: SOLOMON MEDICAL STAFFING AGENCY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1083372668
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOLOMON MEDICAL STAFFING AGENCY LLC

Provider Business Mailing Address
First Line	:	6416 W CAPITOL DR STE 200
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53216-2153
Country	:	US
Telephone Number	:	414-935-2689
Fax Number	:	414-935-2101

Provider Business Practice Location Address
First Line	:	6416 W CAPITOL DR STE 200
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53216-2153
Country	:	US
Telephone Number	:	414-935-2689
Fax Number	:	414-935-2101

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MS. BRANDY SOLOMON
Credential	:
Telephone Number	:	414-935-2689

Provider Enumeration Date	:	12/01/2021
Last Update Date	:	12/01/2021

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