Healthcare Provider Details

I. General information

NPI: 1922777267
Provider Name (Legal Business Name): HENKE HOME HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2021
Last Update Date: 09/10/2021
Certification Date: 09/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3332 MOUNT LN
HUBERTUS WI
53033-9640
US

IV. Provider business mailing address

PO BOX 21
HUBERTUS WI
53033-0021
US

V. Phone/Fax

Practice location:
  • Phone: 262-354-5222
  • Fax: 262-623-6644
Mailing address:
  • Phone: 262-354-5222
  • Fax:

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 Code332U00000X
TaxonomyHome Delivered Meals
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: ANGELA HENKE
Title or Position: OWNER
Credential:
Phone: 262-354-5222