Healthcare Provider Details

I. General information

NPI: 1518271923
Provider Name (Legal Business Name): CR HOME HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2010
Last Update Date: 07/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 KEANE ST
RIDGEWAY WI
53582-9784
US

IV. Provider business mailing address

109 KEANE ST
RIDGEWAY WI
53582-9784
US

V. Phone/Fax

Practice location:
  • Phone: 608-924-0043
  • Fax: 608-924-0021
Mailing address:
  • Phone: 608-924-0043
  • Fax: 608-924-0021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number305985-31
License Number StateWI

VIII. Authorized Official

Name: MRS. CHRISTINE KAY JANZ
Title or Position: OWNER/MANAGER
Credential: LPN
Phone: 608-924-0043