Healthcare Provider Details

I. General information

NPI: 1821627159
Provider Name (Legal Business Name): EXQUISITE CARE HOME SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2020
Last Update Date: 04/07/2020
Certification Date: 04/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3516 N 40TH ST
MILWAUKEE WI
53216-3419
US

IV. Provider business mailing address

3516 N 40TH ST
MILWAUKEE WI
53216-3419
US

V. Phone/Fax

Practice location:
  • Phone: 414-386-3810
  • Fax: 414-386-3811
Mailing address:
  • Phone: 414-386-3810
  • Fax: 414-386-3811

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: CALANDRA HOUSTON
Title or Position: ADMINISTRATOR
Credential:
Phone: 414-386-3810