Healthcare Provider Details

I. General information

NPI: 1083705966
Provider Name (Legal Business Name): TKO HOMECARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 02/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5401 N 76TH ST STE 201
MILWAUKEE WI
53218-2746
US

IV. Provider business mailing address

5401 N 76TH ST STE 201
MILWAUKEE WI
53218-2746
US

V. Phone/Fax

Practice location:
  • Phone: 414-616-8920
  • Fax: 414-616-8910
Mailing address:
  • Phone: 414-616-8920
  • Fax: 414-616-8910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number1052
License Number StateWI

VIII. Authorized Official

Name: MISS KEMBA BANYARD
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 414-616-8920