MEDICARE: OPULENT CARE AGENCY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1033945316
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPULENT CARE AGENCY

Provider Business Mailing Address
First Line	:	4168 N 44TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53216-1504
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4168 N 44TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53216-1504
Country	:	US
Telephone Number	:	414-704-4898
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JEANNETTE HAYNES
Credential	:
Telephone Number	:	414-704-4898

Provider Enumeration Date	:	09/12/2024
Last Update Date	:	09/12/2024

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