Provider Demographics
NPI:1265853998
Name:HMONG HOME HEALTH CARE, LLC
Entity Type:Organization
Organization Name:HMONG HOME HEALTH CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROCKIE
Authorized Official - Middle Name:MA
Authorized Official - Last Name:XIONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-379-0303
Mailing Address - Street 1:2016 BRACKETT AVE
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-4629
Mailing Address - Country:US
Mailing Address - Phone:715-379-0303
Mailing Address - Fax:715-835-7957
Practice Address - Street 1:2016 BRACKETT AVE
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-4629
Practice Address - Country:US
Practice Address - Phone:715-379-0303
Practice Address - Fax:715-835-7957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-24
Last Update Date:2013-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI100033440251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100033440Medicaid