Organization
MIDWEST EMINENCE CARE, LLC
Active
Organization
MIDWEST EMINENCE CARE, LLC
Active
Other names
Midwest Eminence Care
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CRYSTAL AVERY (ADMINISTRATOR)
(262) 789-2759
Entity
Organization
Contact information
Practice address
200 S EXECUTIVE DR STE 101, BROOKFIELD, WI 53005-4216
(262) 789-2759
Mailing address
200 S. EXECUTIVE DRIVE SUITE 101, BROOKFIELD, WI 53005
(262) 789-2759
Taxonomy
Speciality
Code
Description
License number
State
3747P1801X
Personal Care Attendant
Primary
—
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100069896
—
WI
Enumeration date
08/18/2017
Last updated
08/17/2023
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