Healthcare Provider Details

I. General information

NPI: 1578484127
Provider Name (Legal Business Name): SOURCE OF CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6203 WILLIAMSBURG WAY APT 314
DEFOREST WI
53532-9121
US

IV. Provider business mailing address

6203 WILLIAMSBURG WAY APT 314
DEFOREST WI
53532-9121
US

V. Phone/Fax

Practice location:
  • Phone: 608-906-9511
  • Fax:
Mailing address:
  • Phone: 608-906-9511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: GEALE KANE
Title or Position: CEO/OWNER
Credential:
Phone: 608-906-9511