Healthcare Provider Details

I. General information

NPI: 1871159103
Provider Name (Legal Business Name): EAU CLAIRE HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2019
Last Update Date: 05/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2016 BRACKETT AVE
EAU CLAIRE WI
54701-4629
US

IV. Provider business mailing address

2850 COMET CT
EAU CLAIRE WI
54703-0752
US

V. Phone/Fax

Practice location:
  • Phone: 715-514-3491
  • Fax:
Mailing address:
  • Phone: 715-514-3491
  • Fax: 715-514-3492

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: ROCKIE XIONG
Title or Position: OWNER
Credential:
Phone: 715-514-3491