MEDICARE: EXQUISITE CARE HOME SERVICES, 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	:	1821627159
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EXQUISITE CARE HOME SERVICES, LLC

Provider Business Mailing Address
First Line	:	3516 N 40TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53216-3419
Country	:	US
Telephone Number	:	414-386-3810
Fax Number	:	414-386-3811

Provider Business Practice Location Address
First Line	:	3516 N 40TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53216-3419
Country	:	US
Telephone Number	:	414-386-3810
Fax Number	:	414-386-3811

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	CALANDRA HOUSTON
Credential	:
Telephone Number	:	414-386-3810

Provider Enumeration Date	:	04/07/2020
Last Update Date	:	04/07/2020

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