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NPI Code Detail

MEDICARE: PROMINENT HOME CARE

MEDICARE: PROMINENT HOME CARE
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
1251E00000XHome Health Agency

General Provider Information

NPI Number : 1548381429
Entity Type Code : Organization
Provider Name (Legal Business Name) : PROMINENT HOME CARE
Provider Business Mailing Address
First Line : 6263 N GREEN BAY AVE
Second Line :
City : GLENDALE
State : WI
Zip : 53209-3823
Country : US
Telephone Number : 414-351-0938
Fax Number : 414-351-7977
Provider Business Practice Location Address
First Line : 6263 N GREEN BAY AVE
Second Line :
City : GLENDALE
State : WI
Zip : 53209-3823
Country : US
Telephone Number : 414-351-0938
Fax Number : 414-351-7977
Authorized Official
Title or Position : ADMINISTRATOR
Name : MS. SUZANNE M NAVIN
Credential : NHA
Telephone Number : 414-351-0938
Provider Enumeration Date : 04/02/2007
Last Update Date : 08/22/2020

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Directions to “PROMINENT HOME CARE ” Practice Location

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