Healthcare Provider Details

I. General information

NPI: 1912821117
Provider Name (Legal Business Name): ACCESS HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1222 S THOMPSON DR
MADISON WI
53716-1564
US

IV. Provider business mailing address

1222 S THOMPSON DR
MADISON WI
53716-1564
US

V. Phone/Fax

Practice location:
  • Phone: 612-205-0200
  • Fax:
Mailing address:
  • Phone: 612-205-0200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251T00000X
TaxonomyPACE Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: MR. AHMED A KHALIF
Title or Position: ADMINISTRATOR
Credential:
Phone: 612-205-0200