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Contact Information

MIDWEST EMINENCE CARE, LLC
200 S EXECUTIVE DR STE 101
BROOKFIELD, WI53005-4216
 Phone: 262-789-2759
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Personal Care Attendant

3747P1801X
Indicates primary specialty

NPI Profile & details for MIDWEST EMINENCE CARE, LLC

NPI # 1063938264
LBN Legal business name MIDWEST EMINENCE CARE, LLC
Authorized official CRYSTAL AVERY - (ADMINISTRATOR)
Entity Organization
Organization subpart 1 No
Enumeration date 08/18/2017
Last updated 08/17/2023 - About 3 years ago
Identifiers
WI Medicaid 100069896
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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