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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