Healthcare Provider Details

I. General information

NPI: 1598855207
Provider Name (Legal Business Name): SHARON S. RICHARDSON HOSPICE HOME, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 08/23/2024
Certification Date: 08/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

W2862 STATE ROAD 28
SHEBOYGAN FALLS WI
53085
US

IV. Provider business mailing address

W2850 STATE ROAD 28
SHEBOYGAN FALLS WI
53085-2702
US

V. Phone/Fax

Practice location:
  • Phone: 920-467-1800
  • Fax: 920-467-1900
Mailing address:
  • Phone: 920-467-1800
  • Fax: 920-467-1900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH1000X
TaxonomyHospice Registered Nurse
License Number114429-030
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code315D00000X
TaxonomyInpatient Hospice
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MARILYN L MASI
Title or Position: CFO
Credential:
Phone: 920-467-7969