Provider Demographics
NPI:1588236996
Name:COMFORT CARE OF WI LLC
Entity Type:Organization
Organization Name:COMFORT CARE OF WI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:HEKTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:GINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-477-9246
Mailing Address - Street 1:8624A S MARKET PL
Mailing Address - Street 2:
Mailing Address - City:OAK CREEK
Mailing Address - State:WI
Mailing Address - Zip Code:53154-3524
Mailing Address - Country:US
Mailing Address - Phone:414-477-9246
Mailing Address - Fax:
Practice Address - Street 1:8624A S MARKET PL
Practice Address - Street 2:
Practice Address - City:OAK CREEK
Practice Address - State:WI
Practice Address - Zip Code:53154-3524
Practice Address - Country:US
Practice Address - Phone:414-477-9246
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-14
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100170011Medicaid