MEDICARE: LEAN ON ME HOME CARE

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
1	253Z00000X	In Home Supportive Care Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952788945
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEAN ON ME HOME CARE

Provider Business Mailing Address
First Line	:	134 W MADISON AVE
Second Line	:
City	:	GRANTSBURG
State	:	WI
Zip	:	54840-7022
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	134 W MADISON AVE
Second Line	:
City	:	GRANTSBURG
State	:	WI
Zip	:	54840-7022
Country	:	US
Telephone Number	:	715-463-5004
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	NANCY LONGHENRY
Credential	:
Telephone Number	:	715-463-5004

Provider Enumeration Date	:	04/29/2015
Last Update Date	:	04/29/2015

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Directions to “LEAN ON ME HOME CARE ” Practice Location

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