Provider Demographics
NPI:1912209750
Name:HMONG QUALITY HOME CARE, LLC
Entity Type:Organization
Organization Name:HMONG QUALITY HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:TOUA
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-241-9000
Mailing Address - Street 1:1105 GRAND AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:SCHOFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:54476-1168
Mailing Address - Country:US
Mailing Address - Phone:715-241-9000
Mailing Address - Fax:
Practice Address - Street 1:1105 GRAND AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:SCHOFIELD
Practice Address - State:WI
Practice Address - Zip Code:54476-1168
Practice Address - Country:US
Practice Address - Phone:715-241-9000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-30
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI100010309253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100010309Medicaid