Organization
DESTINATION HOME LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHERYL BROWN (OWNER)
(262) 224-6754
Entity
Organization
Contact information
Practice address
S50W30392 SEVILLE LN, MUKWONAGO, WI 53149-8732
(262) 224-6754
Mailing address
S50W30392 SEVILLE LN, MUKWONAGO, WI 53149-8732
(262) 224-6754
Taxonomy
Speciality
Code
Description
License number
State
3747P1801X
Personal Care Attendant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100076054
—
WI
Enumeration date
01/28/2020
Last updated
01/28/2020
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