Healthcare Provider Details

I. General information

NPI: 1316441579
Provider Name (Legal Business Name): COMMUNITY HOME CARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2018
Last Update Date: 03/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

N112 W16298 MEQUON RD 127
GERMANTOWN WI
53022
US

IV. Provider business mailing address

N112W16298 MEQUON RD # 127
GERMANTOWN WI
53022-3306
US

V. Phone/Fax

Practice location:
  • Phone: 414-702-8339
  • Fax: 414-435-3152
Mailing address:
  • Phone: 414-702-8339
  • Fax: 414-435-3152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number100074193
License Number StateWI

VIII. Authorized Official

Name: PAULA NASH
Title or Position: ADMINISTRATOR
Credential:
Phone: 414-702-8339