Provider Demographics
NPI:1255113817
Name:JASMINE HOME CARE LLC
Entity type:Organization
Organization Name:JASMINE HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:MAI HOUA
Authorized Official - Last Name:THAO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-358-7001
Mailing Address - Street 1:1528 N BALLARD RD STE 8
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54911-4252
Mailing Address - Country:US
Mailing Address - Phone:920-358-7001
Mailing Address - Fax:920-202-5108
Practice Address - Street 1:1528 N BALLARD RD STE 8
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911-4252
Practice Address - Country:US
Practice Address - Phone:920-358-7001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-18
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health