# MID AMERICA HEALTHCARE CORP OF WISCONSIN

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1477660132
- **Authorized official:** MS. SOUPHALACK KHAMMYVONG (ADMINISTRATOR/ DON)
- **Authorized official phone:** (414) 578-2961

## Contact information

- **Practice address:** 811 N HAWLEY RD, STE 201, MILWAUKEE, WI 53213-3289
- **Practice address phone:** (414) 578-2961
- **Practice address fax:** (414) 578-2962
- **Mailing address:** 811 N HAWLEY RD, MILWAUKEE, WI 53213-3289
- **Mailing address phone:** (414) 578-2961
- **Mailing address fax:** (414) 578-2962

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251E00000X | Home Health Agency | 527256 | WI | Yes |

## Other

- **Enumeration date:** 08/25/2006
- **Last updated:** 02/10/2012