=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245656859
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HMONG SENIOR CENTER, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/07/2014
-----------------------------------------------------
Last Update Date | 03/07/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1724 WESTGATE RD
-----------------------------------------------------
City | EAU CLAIRE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54703-4963
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 715-379-0303
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1724 WESTGATE RD
-----------------------------------------------------
City | EAU CLAIRE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54703-4963
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR/MANAGER
-----------------------------------------------------
Name | ROCKIE MA XIONG
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 715-379-0303
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251G00000X
-----------------------------------------------------
Taxonomy Name | Community Based Hospice Care Agency
-----------------------------------------------------
License Number | 14797
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------