Provider Demographics
NPI:1992176861
Name:MIDWEST HOME HEALTH CARE
Entity type:Organization
Organization Name:MIDWEST HOME HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAI GE
Authorized Official - Middle Name:
Authorized Official - Last Name:VANG
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:920-965-9112
Mailing Address - Street 1:2475 UNIVERSITY AVE
Mailing Address - Street 2:UNIT J
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54302-5099
Mailing Address - Country:US
Mailing Address - Phone:920-965-9112
Mailing Address - Fax:920-965-9111
Practice Address - Street 1:2475 UNIVERSITY AVE
Practice Address - Street 2:UNIT J
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54302-5099
Practice Address - Country:US
Practice Address - Phone:920-965-9112
Practice Address - Fax:920-965-9111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-16
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100040357Medicaid