Provider Demographics
NPI:1265899066
Name:PASOUA HOME CARE, LLC
Entity type:Organization
Organization Name:PASOUA HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR/RN
Authorized Official - Prefix:
Authorized Official - First Name:PA SOUA
Authorized Official - Middle Name:
Authorized Official - Last Name:VUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-212-7703
Mailing Address - Street 1:508 W WISCONSIN AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54911-4337
Mailing Address - Country:US
Mailing Address - Phone:920-358-7902
Mailing Address - Fax:
Practice Address - Street 1:508 W WISCONSIN AVE
Practice Address - Street 2:SUITE B
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911-4337
Practice Address - Country:US
Practice Address - Phone:920-358-7902
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-25
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100037071Medicaid