# MED GROUP HOME HEALTH CARE AGENCY LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Med Group Home Health Care Agency
- **Organization subpart:** No

## Provider details

- **NPI number:** 1306398110
- **Authorized official:** DARIKO MEKVABISHVILI (OWNER)
- **Authorized official phone:** (414) 755-2103

## Contact information

- **Practice address:** 11053 N TOWNE SQUARE RD, MEQUON, WI 53092-5051
- **Practice address phone:** (414) 755-2103
- **Practice address fax:** (414) 755-1784
- **Mailing address:** 11053 N TOWNE SQUARE RD, MEQUON, WI 53092-5051
- **Mailing address phone:** (414) 755-2103
- **Mailing address fax:** (414) 755-1784

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251E00000X | Home Health Agency | 1194 | WI | Yes |

## Other

- **Enumeration date:** 10/27/2016
- **Last updated:** 10/27/2016