Healthcare Provider Details

I. General information

NPI: 1487208294
Provider Name (Legal Business Name): ANGELS ON WHEELS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2019
Last Update Date: 07/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75734 WEST RD
BUTTERNUT WI
54514-9149
US

IV. Provider business mailing address

75734 WEST RD
BUTTERNUT WI
54514-9149
US

V. Phone/Fax

Practice location:
  • Phone: 715-661-3650
  • Fax:
Mailing address:
  • Phone: 715-661-3650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: MS. LISA R RIECKMAN
Title or Position: BOOKKEEPER
Credential:
Phone: 715-661-3650