Healthcare Provider Details

I. General information

NPI: 1992626204
Provider Name (Legal Business Name): NOURISHCARE WISCONSIN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3957 N 39TH ST
MILWAUKEE WI
53216-2516
US

IV. Provider business mailing address

3957 N 39TH ST
MILWAUKEE WI
53216-2516
US

V. Phone/Fax

Practice location:
  • Phone: 920-717-3302
  • Fax:
Mailing address:
  • Phone: 920-717-3302
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number
License Number State

VIII. Authorized Official

Name: MISS CASSHEA FOWLER
Title or Position: OWNER
Credential:
Phone: 920-717-3302