=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760930630
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CONFIDENT CARE HOME HEALTH SERVICES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/20/2016
-----------------------------------------------------
Last Update Date | 09/20/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9001 N 76TH ST SUITE 300
-----------------------------------------------------
City | MILWAUKEE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53223-1911
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-797-2245
-----------------------------------------------------
Fax | 414-797-2244
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9001 N 76TH ST SUITE 300
-----------------------------------------------------
City | MILWAUKEE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53223-1911
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-797-2245
-----------------------------------------------------
Fax | 414-797-2244
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MAIKER YANG
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 414-797-2245
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------