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General NPI Number Information
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NPI Number | 1720576598
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Entity Type | Organization
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Legal Business Name | XAVIER HOME HEALTHCARE
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Dates
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Enumeration Date | 04/27/2018
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Last Update Date | 04/27/2018
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Provider Practice Location Address
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Address Line | 1661 N WATER ST STE 504
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City | MILWAUKEE
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State | WI
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Zip | 53202-2086
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Country | US
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Telephone | 773-441-1910
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Fax | 414-386-7913
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Provider Business Mailing Address
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Address Line | 1661 N WATER ST STE 504
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City | MILWAUKEE
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State | WI
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Zip | 53202-2086
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Country | US
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Telephone | 773-441-1910
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Fax | 414-386-7913
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Authorized Official
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Title or Position | CEO
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Name | MR. JERMAINE YOUNG
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Credential |
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Telephone | 773-441-1910
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 100034505
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License Number State | WI
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