Provider Demographics
NPI:1841660396
Name:COMPASSIONATE CARE HOME HEALTH CARE LLC
Entity type:Organization
Organization Name:COMPASSIONATE CARE HOME HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:WELCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-326-0503
Mailing Address - Street 1:6051 W BROWN DEER RD STE 105
Mailing Address - Street 2:
Mailing Address - City:BROWN DEER
Mailing Address - State:WI
Mailing Address - Zip Code:53223-2263
Mailing Address - Country:US
Mailing Address - Phone:414-269-8506
Mailing Address - Fax:414-877-6051
Practice Address - Street 1:6051 W BROWN DEER RD
Practice Address - Street 2:SUITE 101
Practice Address - City:BROWN DEER
Practice Address - State:WI
Practice Address - Zip Code:53223-2263
Practice Address - Country:US
Practice Address - Phone:414-269-8506
Practice Address - Fax:414-877-6051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-27
Last Update Date:2018-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI153487-30253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100043185Medicaid