Organization
MIRACLE HOME HEALTH OF WISCONSIN INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ARKADIY KOPSHTEYN MBA (CEO/OWNER)
(414) 797-2254
Entity
Organization
Contact information
Practice address
7545 N PORT WASHINGTON RD STE 3, GLENDALE, WI 53217-3422
(414) 797-2254
(888) 910-5128
Mailing address
7545 N PORT WASHINGTON RD STE 3, GLENDALE, WI 53217-3422
(414) 915-0838
(414) 797-4544
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
1174
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100039227
—
WI
Enumeration date
03/26/2012
Last updated
10/24/2023
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