Provider Demographics
NPI:1508391988
Name:ADORABLE HOME HEALTH CARE LLC
Entity Type:Organization
Organization Name:ADORABLE HOME HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:IGONI
Authorized Official - Middle Name:
Authorized Official - Last Name:IGONI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-236-4157
Mailing Address - Street 1:6110 W CAPITOL DR
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53216-2120
Mailing Address - Country:US
Mailing Address - Phone:414-236-4157
Mailing Address - Fax:414-509-1648
Practice Address - Street 1:6110 W CAPITOL DR
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53216-2120
Practice Address - Country:US
Practice Address - Phone:414-236-4157
Practice Address - Fax:414-509-1648
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-24
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIPCA365251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100064359Medicaid