Provider Demographics
NPI:1598048001
Name:TONGXENG PERSONAL HOME CARE, LLC
Entity Type:Organization
Organization Name:TONGXENG PERSONAL HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MAIYOUA
Authorized Official - Middle Name:
Authorized Official - Last Name:THAO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-734-1702
Mailing Address - Street 1:PO BOX 2464
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54912-2464
Mailing Address - Country:US
Mailing Address - Phone:920-734-1702
Mailing Address - Fax:920-734-1703
Practice Address - Street 1:206 S MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911-5839
Practice Address - Country:US
Practice Address - Phone:920-734-1702
Practice Address - Fax:920-734-1703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-21
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI100011481251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100011481Medicaid