Provider Demographics
NPI:1922561778
Name:NEW CENTURY HOME CARE LLC
Entity type:Organization
Organization Name:NEW CENTURY HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NIKK
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-685-8568
Mailing Address - Street 1:W175N11117 STONEWOOD DR STE 206
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53022-6506
Mailing Address - Country:US
Mailing Address - Phone:262-478-0732
Mailing Address - Fax:262-478-0734
Practice Address - Street 1:W175N11117 STONEWOOD DR STE 206
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:WI
Practice Address - Zip Code:53022-6506
Practice Address - Country:US
Practice Address - Phone:262-478-0732
Practice Address - Fax:262-478-0734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-09
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100091685Medicaid