Provider Demographics
NPI:1245748847
Name:COMPREHENSIVE HOME CARE, LLC.
Entity Type:Organization
Organization Name:COMPREHENSIVE HOME CARE, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:OBED
Authorized Official - Last Name:PENA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-585-0083
Mailing Address - Street 1:2800 W FOREST HOME AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-2945
Mailing Address - Country:US
Mailing Address - Phone:414-585-0083
Mailing Address - Fax:414-252-5090
Practice Address - Street 1:2800 W FOREST HOME AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215-2945
Practice Address - Country:US
Practice Address - Phone:414-585-0083
Practice Address - Fax:414-252-5090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-17
Last Update Date:2018-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI100035439251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100035439Medicaid