=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053291591
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NORTHERN HOME CARE GROUP SC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/04/2025
-----------------------------------------------------
Last Update Date | 09/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5477 N HOPKINS ST
-----------------------------------------------------
City | MILWAUKEE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53209-4637
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 262-617-5018
-----------------------------------------------------
Fax | 262-617-5018
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5477 N HOPKINS ST
-----------------------------------------------------
City | MILWAUKEE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53209-4637
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 262-617-5018
-----------------------------------------------------
Fax | 262-617-5018
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | FREDERICK PHILLIPS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 262-617-5018
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------