Healthcare Provider Details

I. General information

NPI: 1346233988
Provider Name (Legal Business Name): LA SANTE WISCONSIN INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2005
Last Update Date: 02/27/2026
Certification Date: 02/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 RIVERSIDE DR
GREEN BAY WI
54301-2320
US

IV. Provider business mailing address

PO BOX 1415
GREEN BAY WI
54305-1415
US

V. Phone/Fax

Practice location:
  • Phone: 920-465-3000
  • Fax: 920-465-3003
Mailing address:
  • Phone: 920-465-3000
  • Fax: 920-465-3003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number2584-45
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number2584-45
License Number StateWI

VIII. Authorized Official

Name: JAROD HUSMANN
Title or Position: PRESIDENT
Credential:
Phone: 920-884-5327