Provider Demographics
NPI:1912296294
Name:BADGER HEALTHCARE AGENCY, LLC
Entity Type:Organization
Organization Name:BADGER HEALTHCARE AGENCY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ABUBAKAR
Authorized Official - Middle Name:BIN
Authorized Official - Last Name:SA-EED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-372-0905
Mailing Address - Street 1:1317 W BROWN ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53205-1223
Mailing Address - Country:US
Mailing Address - Phone:414-372-0905
Mailing Address - Fax:
Practice Address - Street 1:1317 W BROWN ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53205-1223
Practice Address - Country:US
Practice Address - Phone:414-372-0905
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-07
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health