=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699051946
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ABCW HOME HEALTH CARE AGENCY,LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/01/2011
-----------------------------------------------------
Last Update Date | 04/30/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1672 S 9TH ST UNIT B
-----------------------------------------------------
City | MILWAUKEE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53204-3426
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-643-5985
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1672 S 9TH ST UNIT B
-----------------------------------------------------
City | MILWAUKEE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53204-3426
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-643-5985
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | ABDIWAHAB M YUSUF
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 414-643-5985
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 1162
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------