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Contact Information

DESTINATION HOME LLC
S50W30392 SEVILLE LN
MUKWONAGO, WI53149-8732
 Phone: 262-224-6754
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Personal Care Attendant

3747P1801X
Indicates primary specialty

NPI Profile & details for DESTINATION HOME LLC

NPI Number 1124659339
LBN Legal business name DESTINATION HOME LLC
Authorized official CHERYL BROWN - (OWNER)
Entity Organization
Organization subpart 1 No
Enumeration date 01/28/2020
Last updated 01/28/2020 - About 6 years ago
Identifiers
WI Medicaid 100076054
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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