MEDICARE: TKO HOMECARE

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	163WH0200X	Home Health Registered Nurse	1052	WI

General Provider Information

NPI Number	:	1083705966
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TKO HOMECARE

Provider Business Mailing Address
First Line	:	5401 N 76TH ST STE 201
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53218-2746
Country	:	US
Telephone Number	:	414-616-8920
Fax Number	:	414-616-8910

Provider Business Practice Location Address
First Line	:	5401 N 76TH ST STE 201
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53218-2746
Country	:	US
Telephone Number	:	414-616-8920
Fax Number	:	414-616-8910

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MISS KEMBA BANYARD
Credential	:	RN
Telephone Number	:	414-616-8920

Provider Enumeration Date	:	09/27/2006
Last Update Date	:	02/29/2008

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