Healthcare Provider Details

I. General information

NPI: 1043250558
Provider Name (Legal Business Name): IN HOME HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 04/14/2022
Certification Date: 04/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10200 W INNOVATION DR STE 400
MILWAUKEE WI
53226-4826
US

IV. Provider business mailing address

333 N SUMMIT ST
TOLEDO OH
43604-1531
US

V. Phone/Fax

Practice location:
  • Phone: 414-944-2000
  • Fax:
Mailing address:
  • Phone: 419-254-7841
  • Fax: 419-252-6448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number2003
License Number StateWI

VIII. Authorized Official

Name: MARTIN DAVID ALLEN
Title or Position: DIRECTOR
Credential:
Phone: 419-252-5734