MEDICARE: CHAMPION 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	251E00000X	Home Health Agency		WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699268789
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHAMPION HOME HEALTH CARE, LLC

Provider Business Mailing Address
First Line	:	2537 W SCOTT ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53204-1959
Country	:	US
Telephone Number	:	414-255-9050
Fax Number	:	414-255-9052

Provider Business Practice Location Address
First Line	:	2537 W SCOTT ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53204-1959
Country	:	US
Telephone Number	:	414-255-9050
Fax Number	:	414-255-9052

Authorized Official
Title or Position	:	OWNER / ADMINISTRATOR
Name	:	BRANDON RULE
Credential	:
Telephone Number	:	414-255-9050

Provider Enumeration Date	:	06/13/2018
Last Update Date	:	06/13/2018

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Directions to “CHAMPION HOME HEALTH CARE, LLC ” Practice Location

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