Healthcare Provider Details

I. General information

NPI: 1083586366
Provider Name (Legal Business Name): DESIREE THOMAS CBRF TRAINING
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2025
Last Update Date: 09/18/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1538 PACKARD AVE
RACINE WI
53403-2147
US

IV. Provider business mailing address

N63W23819 TERRACE DR
SUSSEX WI
53089-3152
US

V. Phone/Fax

Practice location:
  • Phone: 262-456-0065
  • Fax:
Mailing address:
  • Phone: 414-403-0563
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: