MEDICARE: RIVER WEST HOME CARE ASSISTANT, 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	251E00000X	Home Health Agency		WI

General Provider Information

NPI Number	:	1164853545
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIVER WEST HOME CARE ASSISTANT, LLC

Provider Business Mailing Address
First Line	:	234 W FLORIDA ST STE 311
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53204-1659
Country	:	US
Telephone Number	:	414-722-5436
Fax Number	:

Provider Business Practice Location Address
First Line	:	234 W FLORIDA ST STE 311
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53204-1659
Country	:	US
Telephone Number	:	414-722-5436
Fax Number	:

Authorized Official
Title or Position	:	CEO/PRESIDENT
Name	:	MR. ISMAIL HARUN
Credential	:
Telephone Number	:	414-722-5436

Provider Enumeration Date	:	12/10/2013
Last Update Date	:	12/10/2013

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