Provider Demographics
NPI:1720576598
Name:XAVIER HOME HEALTHCARE
Entity Type:Organization
Organization Name:XAVIER HOME HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JERMAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-441-1910
Mailing Address - Street 1:1661 N WATER ST STE 504
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-2086
Mailing Address - Country:US
Mailing Address - Phone:773-441-1910
Mailing Address - Fax:414-386-7913
Practice Address - Street 1:1661 N WATER ST STE 504
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-2086
Practice Address - Country:US
Practice Address - Phone:773-441-1910
Practice Address - Fax:414-386-7913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-27
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI100034505251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100034505Medicaid