Healthcare Provider Details

I. General information

NPI: 1285623223
Provider Name (Legal Business Name): SUPPORTIVE HOME SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2005
Last Update Date: 10/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1181 4TH AVE N
PARK FALLS WI
54552-1732
US

IV. Provider business mailing address

1181 4TH AVE N
PARK FALLS WI
54552-1732
US

V. Phone/Fax

Practice location:
  • Phone: 715-762-3200
  • Fax: 715-762-3359
Mailing address:
  • Phone: 715-762-3200
  • Fax: 715-762-3359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number202
License Number StateWI

VIII. Authorized Official

Name: ANNE OSWALD-BALSAVICH
Title or Position: ADMINISTRATOR
Credential:
Phone: 715-762-3200