MEDICARE: QUALITY HOME CARE AGENCY 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

General Provider Information

NPI Number	:	1922503788
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	QUALITY HOME CARE AGENCY LLC

Provider Business Mailing Address
First Line	:	5037 SAINT ANNES DR
Second Line	:
City	:	MIDDLETON
State	:	WI
Zip	:	53597-8826
Country	:	US
Telephone Number	:	608-416-9175
Fax Number	:

Provider Business Practice Location Address
First Line	:	5037 SAINT ANNES DR
Second Line	:
City	:	MIDDLETON
State	:	WI
Zip	:	53597-8826
Country	:	US
Telephone Number	:	608-416-9175
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	HASSAN HAJI-ABDIRAHMAN
Credential	:
Telephone Number	:	608-416-9175

Provider Enumeration Date	:	03/26/2018
Last Update Date	:	03/26/2018

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