Organization
TRI-STAR HOME CARE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KOUA F THAO (MANAGER)
(414) 897-0050
Entity
Organization
Contact information
Practice address
4250 W FOND DU LAC AVE, MILWAUKEE, WI 53216-3564
(414) 897-0050
(414) 897-0052
Mailing address
4250 W FOND DU LAC AVE, MILWAUKEE, WI 53216-3564
(414) 897-0050
(414) 897-0052
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
100034442
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100034442
—
WI
Enumeration date
09/13/2017
Last updated
07/21/2022
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