Destination Home LLC
Organization Active NPI Personal Care Attendant · Mukwonago, WI
NPI 1124659339 · NPPES record last updated Jan 28, 2020
Key facts
- NPI
- 1124659339
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Personal Care Attendant 3747P1801X
- Legal business name
- DESTINATION HOME LLC
- Practice address
- S50W30392 Seville LN
Mukwonago, WI 53149-8732 - Phone
- (262) 224-6754
- NPI assigned
- Jan 28, 2020
- Organization subpart
- No
Authorized official
- Name
- Cheryl Brown
- Title
- Owner
- Phone
- (262) 224-6754
Practitioners 1
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Personal Care Attendant |
3747P1801X | Yes |
Addresses
Primary practice location
S50W30392 Seville LN
Mukwonago, WI 53149-8732
Mailing address
S50W30392 Seville LN
Mukwonago, WI 53149-8732
Phone (262) 224-6754
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100076054 | Medicaid | WI |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | Mukwonago |
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- Julie A. Doyle
- Melissa Eichler
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All providers in Mukwonago, WI · Personal Care Attendant in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 28, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.