MEDICARE: NELSON HOME HEALTH CARE LLC

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	311ZA0620X	Adult Care Home Facility	15964	WI

General Provider Information

NPI Number	:	1043701634
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NELSON HOME HEALTH CARE LLC

Provider Business Mailing Address
First Line	:	7305 W CRAWFORD AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53220-1729
Country	:	US
Telephone Number	:	262-497-6294
Fax Number	:

Provider Business Practice Location Address
First Line	:	7303 W CRAWFORD AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53220-1729
Country	:	US
Telephone Number	:	262-497-6294
Fax Number	:

Authorized Official
Title or Position	:	CO-OWNER
Name	:	MR. DAVID MARK NELSON
Credential	:
Telephone Number	:	262-497-6294

Provider Enumeration Date	:	05/20/2018
Last Update Date	:	05/20/2018

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