Healthcare Provider Details

I. General information

NPI: 1770938557
Provider Name (Legal Business Name): BALLARD ENTERPRISES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2016
Last Update Date: 12/13/2023
Certification Date: 12/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

990 HILLCREST ST STE 101
BALDWIN WI
54002-9263
US

IV. Provider business mailing address

PO BOX 353
ROBERTS WI
54023-0353
US

V. Phone/Fax

Practice location:
  • Phone: 651-334-6587
  • Fax: 888-834-4115
Mailing address:
  • Phone: 651-334-6587
  • Fax: 888-834-4115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateWI

VIII. Authorized Official

Name: KENNETH BALLARD
Title or Position: OWNER
Credential:
Phone: 715-245-1944