Provider Demographics
NPI:1598111072
Name:SE ADULT HOME CARE, LLC.
Entity Type:Organization
Organization Name:SE ADULT HOME CARE, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CAREGIVER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:ERNO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-892-2665
Mailing Address - Street 1:11662 SHERWOOD LN
Mailing Address - Street 2:
Mailing Address - City:ARBOR VITAE
Mailing Address - State:WI
Mailing Address - Zip Code:54568-9242
Mailing Address - Country:US
Mailing Address - Phone:715-892-2665
Mailing Address - Fax:
Practice Address - Street 1:11662 SHERWOOD LN
Practice Address - Street 2:
Practice Address - City:ARBOR VITAE
Practice Address - State:WI
Practice Address - Zip Code:54568-9242
Practice Address - Country:US
Practice Address - Phone:715-892-2665
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-13
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care