Healthcare Provider Details

I. General information

NPI: 1366238339
Provider Name (Legal Business Name): UBAH RAGE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2025
Last Update Date: 01/01/2026
Certification Date: 01/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2633 W CAPITOL DR
APPLETON WI
54914-6601
US

IV. Provider business mailing address

2633 W CAPITOL DR
APPLETON WI
54914-6601
US

V. Phone/Fax

Practice location:
  • Phone: 608-888-4853
  • Fax:
Mailing address:
  • Phone: 608-888-4853
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: