Healthcare Provider Details

I. General information

NPI: 1912481185
Provider Name (Legal Business Name): VISITING NURSE COMMUNITY CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2018
Last Update Date: 09/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 52ND ST STE 300
KENOSHA WI
53140-3423
US

IV. Provider business mailing address

600 52ND ST STE 300
KENOSHA WI
53140-3423
US

V. Phone/Fax

Practice location:
  • Phone: 262-656-8400
  • Fax: 262-657-1468
Mailing address:
  • Phone: 262-656-8400
  • Fax: 262-657-1468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SUSAN HOUTE
Title or Position: DOF
Credential:
Phone: 262-925-2086