Healthcare Provider Details

I. General information

NPI: 1902713548
Provider Name (Legal Business Name): PROVISIONAL STAFFING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2128 E PRAIRIE CREEK DR
NEENAH WI
54956-5623
US

IV. Provider business mailing address

1461 KENWOOD DR
MENASHA WI
54952-1153
US

V. Phone/Fax

Practice location:
  • Phone: 920-470-9167
  • Fax: 920-969-0527
Mailing address:
  • Phone: 920-470-9167
  • Fax: 920-969-0527

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL C MCCARTHY
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 920-470-9167