Provider Demographics
NPI:1780338293
Name:PROMINENT HEALTHCARE LLC
Entity type:Organization
Organization Name:PROMINENT HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AVA MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:STOKES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-966-3400
Mailing Address - Street 1:5215 N IRONWOOD RD STE 202-I1
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53217-4915
Mailing Address - Country:US
Mailing Address - Phone:414-966-3400
Mailing Address - Fax:414-966-3401
Practice Address - Street 1:5215 N IRONWOOD RD STE 202-I1
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53217-4915
Practice Address - Country:US
Practice Address - Phone:414-966-3400
Practice Address - Fax:414-966-3401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-04
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health