Healthcare Provider Details

I. General information

NPI: 1992126338
Provider Name (Legal Business Name): DIVERSE CARE LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2014
Last Update Date: 01/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

N5881 LAKEVIEW CT E
ONALASKA WI
54650-9642
US

IV. Provider business mailing address

N5881 LAKEVIEW CT E
ONALASKA WI
54650-9642
US

V. Phone/Fax

Practice location:
  • Phone: 608-304-5053
  • Fax: 608-519-5012
Mailing address:
  • Phone: 608-304-5053
  • Fax: 608-519-5012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: AMY THESING
Title or Position: OWNER/ADMINISTRATOR
Credential: RN
Phone: 608-304-5053