Provider Demographics
NPI:1164853545
Name:RIVER WEST HOME CARE ASSISTANT, LLC
Entity Type:Organization
Organization Name:RIVER WEST HOME CARE ASSISTANT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ISMAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:HARUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-722-5436
Mailing Address - Street 1:234 W FLORIDA ST STE 311
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53204-1659
Mailing Address - Country:US
Mailing Address - Phone:414-722-5436
Mailing Address - Fax:
Practice Address - Street 1:234 W FLORIDA ST STE 311
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53204-1659
Practice Address - Country:US
Practice Address - Phone:414-722-5436
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-10
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health