Healthcare Provider Details

I. General information

NPI: 1932010063
Provider Name (Legal Business Name): LEGACY OF MAF HOME HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 S PARK ST
MADISON WI
53715-1828
US

IV. Provider business mailing address

622 S PARK ST
MADISON WI
53715-1828
US

V. Phone/Fax

Practice location:
  • Phone: 608-940-7836
  • Fax: 608-650-6337
Mailing address:
  • Phone: 608-940-7836
  • Fax: 608-650-6337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. MOHAMED OSMAN AHMED
Title or Position: CO-OWNER
Credential:
Phone: 608-940-7836