MEDICARE: FAMILY 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	253Z00000X	In Home Supportive Care Agency	PCA125	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	:	1922326040
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY HOME HEALTH CARE, LLC

Provider Business Mailing Address
First Line	:	3726 W NATIONAL AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53215-1008
Country	:	US
Telephone Number	:	414-897-6884
Fax Number	:	414-383-1903

Provider Business Practice Location Address
First Line	:	3726 W NATIONAL AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53215-1008
Country	:	US
Telephone Number	:	414-897-6884
Fax Number	:	414-383-1903

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	MR. RICK K VANG
Credential	:
Telephone Number	:	414-897-6884

Provider Enumeration Date	:	05/13/2010
Last Update Date	:	03/13/2014

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