Healthcare Provider Details

I. General information

NPI: 1124053038
Provider Name (Legal Business Name): IN HOME HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1233 N MAYFAIR RD SUITE 100
MILWAUKEE WI
53226-3276
US

IV. Provider business mailing address

333 N SUMMIT ST ATTN: DEAN SHIPMAN
TOLEDO OH
43604-1531
US

V. Phone/Fax

Practice location:
  • Phone: 414-944-2000
  • Fax: 414-944-2086
Mailing address:
  • Phone: 419-254-7841
  • Fax: 419-252-6448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number280
License Number StateWI

VIII. Authorized Official

Name: MR. MARTIN D ALLEN
Title or Position: DIRECTOR
Credential:
Phone: 419-252-5734