Organization Active NPI

Tri-Star Home Care, LLC

  • In Home Supportive Care Agency
  • Milwaukee, WI
National Provider Identifier
1780103531
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
In Home Supportive Care AgencyTaxonomy code 253Z00000X
License
100034442 Issued in WI
Legal business name
TRI-STAR HOME CARE, LLC
Practice address
4250 W Fond Du Lac Ave
Milwaukee, WI 53216-3564
Phone
(414) 897-0050
Fax
(414) 897-0052
NPI assigned
Sep 13, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Mr. Koua F Thao
Title
Manager
Phone
(414) 897-0050

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
In Home Supportive Care Agency 253Z00000X 100034442 WI Primary

Addresses

Primary practice location

4250 W Fond Du Lac Ave
Milwaukee, WI 53216-3564

Mailing address

4250 W Fond Du Lac Ave
Milwaukee, WI 53216-3564
Phone (414) 897-0050

Other identifiers 1

IdentifierTypeStateIssuer
100034442MedicaidWI

National Provider Directory

National Provider Directory

Locations

4250 W Fond du Lac Ave
Milwaukee, WI 53216
Phone (414) 897-0050

NPI Registry JSON

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

{
    "created_epoch": "1505260800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1780103531",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4250 W FOND DU LAC AVE",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532163564",
            "telephone_number": "414-897-0050",
            "fax_number": "414-897-0052"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4250 W FOND DU LAC AVE",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532163564",
            "telephone_number": "414-897-0050",
            "fax_number": "414-897-0052"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRI-STAR HOME CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-09-13",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "THAO",
        "authorized_official_first_name": "KOUA",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "414-897-0050",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": "WI",
            "license": "100034442",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100034442",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Milwaukee, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.