Healthcare Provider Details

I. General information

NPI: 1992960413
Provider Name (Legal Business Name): XTREME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2008
Last Update Date: 07/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

W1662 NORTH ST
GREEN LAKE WI
54941-9029
US

IV. Provider business mailing address

241 E FOLLETT ST
FOND DU LAC WI
54935-3542
US

V. Phone/Fax

Practice location:
  • Phone: 920-960-2138
  • Fax:
Mailing address:
  • Phone: 920-960-2138
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number6600147
License Number StateWI

VIII. Authorized Official

Name: DENNIS CAYWOOD
Title or Position: MANAGER
Credential:
Phone: 920-960-2138