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NPI Code Detail

MEDICARE: INDEPENDENCE CARE OF WISCONSIN LLC

MEDICARE: INDEPENDENCE CARE OF WISCONSIN LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251E00000XHome Health Agency

General Provider Information

NPI Number : 1649974908
Entity Type Code : Organization
Provider Name (Legal Business Name) : INDEPENDENCE CARE OF WISCONSIN LLC
Provider Business Mailing Address
First Line : 3301 BONITA BEACH RD STE 208
Second Line :
City : BONITA SPRINGS
State : FL
Zip : 34134-7835
Country : US
Telephone Number : 603-520-1603
Fax Number :
Provider Business Practice Location Address
First Line : 1366 E SUMNER ST
Second Line :
City : HARTFORD
State : WI
Zip : 53027-1614
Country : US
Telephone Number : 845-559-3081
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : ALLISON VIAR
Credential :
Telephone Number : 845-559-3081
Provider Enumeration Date : 03/29/2023
Last Update Date : 05/28/2026

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Directions to “INDEPENDENCE CARE OF WISCONSIN LLC ” Practice Location

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