Healthcare Provider Details

I. General information

NPI: 1518254945
Provider Name (Legal Business Name): THERAPEUTIC HOME SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2011
Last Update Date: 07/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9484 FESTIVAL AVENUE
SPARTA WI
54656
US

IV. Provider business mailing address

9484 FESTIVAL AVENUE
SPARTA WI
54656
US

V. Phone/Fax

Practice location:
  • Phone: 608-366-1269
  • Fax: 608-781-4204
Mailing address:
  • Phone: 608-366-1269
  • Fax: 608-781-4204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number3666-026
License Number StateWI

VIII. Authorized Official

Name: MEGAN STEELE
Title or Position: CO OWNER
Credential: OTR
Phone: 608-366-1269