# MED GROUP HOME HEALTH CARE AGENCY

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

## Provider details

- **NPI number:** 1609147958
- **Authorized official:** DARIKO MEKVABISHVILI (PRESIDENT)
- **Authorized official phone:** (414) 745-3146

## Contact information

- **Practice address:** 11402 N PORT WASHINGTON RD, SUITE 214 B, MEQUON, WI 53092-3447
- **Practice address phone:** (414) 755-2009
- **Practice address fax:** (414) 755-1767
- **Mailing address:** 2111 N DR MARTIN LUTHER KING DR, MILWAUKEE, WI 53212-3101
- **Mailing address phone:** (414) 755-2103
- **Mailing address fax:** (414) 755-1784

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251E00000X | Home Health Agency | — | NULL | Yes |

## Other

- **Enumeration date:** 01/18/2012
- **Last updated:** 09/25/2014