Med Group Adult Day Care of Wi, LLC

Primary specialty

Custodial Care FacilityTaxonomy code 311Z00000X

Legal business name

MED GROUP ADULT DAY CARE OF WI, LLC

Practice address

10549 W Forest Home Ave
Hales Corners, WI 53130-2057

Phone

(414) 755-0558

Fax

(414) 755-2470

NPI assigned

Sep 13, 2012

Last updated

Sep 13, 2012By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dariko Mekvabishvili

Title

President

Phone

(414) 755-0558

Specialties & licenses 1

Addresses

Tax ID family

Med Group Adult Day Care of Wi2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Med Group Adult Day Care of Wi

  • Adult Day Care Clinic/Center
  • Franklin, WI
  • NPI 1154750511
  NPD tax ID

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1347494400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1347494400000",
    "number": "1437409737",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10549 W FOREST HOME AVE",
            "city": "HALES CORNERS",
            "state": "WI",
            "postal_code": "531302057",
            "telephone_number": "414-755-0558",
            "fax_number": "414-755-2470"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10549 W FOREST HOME AVE",
            "city": "HALES CORNERS",
            "state": "WI",
            "postal_code": "531302057",
            "telephone_number": "414-755-0558",
            "fax_number": "414-755-2470"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MED GROUP ADULT DAY CARE OF WI, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-09-13",
        "last_updated": "2012-09-13",
        "status": "A",
        "authorized_official_last_name": "MEKVABISHVILI",
        "authorized_official_first_name": "DARIKO",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "414-755-0558"
    },
    "taxonomies": [
        {
            "code": "311Z00000X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Farzaneh Masool Tondkar, M.D.
• Leah Matte, M.T.
• Mitchell Matthews, DC
• Doris K Mayer, CAC
• Lauren J McCarthy, LPC, MS
• Medsource LLC
• Elsa Meiss, PT, DPT
• Mi Casa Care
• Midwest Orthopedic Specialty Hospital, LLC
• Midwest Orthopedic Specialty Hospital, LLC

• Custodial Care Facility in Hales Corners, WI
• Providers in Hales Corners, WI by specialty
• Custodial Care Facility in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.