Healthcare Provider Details

I. General information

NPI: 1265988117
Provider Name (Legal Business Name): OBI HOME CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2016
Last Update Date: 08/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4439 S 20TH ST
MILWAUKEE WI
53221
US

IV. Provider business mailing address

4441 S 20TH ST
MILWAUKEE WI
53221-2301
US

V. Phone/Fax

Practice location:
  • Phone: 414-334-0252
  • Fax:
Mailing address:
  • Phone: 414-334-0252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number0016048
License Number StateWI

VIII. Authorized Official

Name: JAMILA S. MAHMOUD
Title or Position: OWNER
Credential: 0016048
Phone: 414-334-0252