MEDICARE: MIDWEST HOME HEALTH 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
1	253Z00000X	In Home Supportive Care Agency

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	:	1992176861
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIDWEST HOME HEALTH CARE

Provider Business Mailing Address
First Line	:	2475 UNIVERSITY AVE
Second Line	:	UNIT J
City	:	GREEN BAY
State	:	WI
Zip	:	54302-5099
Country	:	US
Telephone Number	:	920-965-9112
Fax Number	:	920-965-9111

Provider Business Practice Location Address
First Line	:	2475 UNIVERSITY AVE
Second Line	:	UNIT J
City	:	GREEN BAY
State	:	WI
Zip	:	54302-5099
Country	:	US
Telephone Number	:	920-965-9112
Fax Number	:	920-965-9111

Authorized Official
Title or Position	:	CO-OWNER
Name	:	MAI GE VANG
Credential	:	RN
Telephone Number	:	920-965-9112

Provider Enumeration Date	:	10/16/2015
Last Update Date	:	10/16/2015

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Directions to “MIDWEST HOME HEALTH CARE ” Practice Location

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