Healthcare Provider Details

I. General information

NPI: 1164994117
Provider Name (Legal Business Name): COPPERLEAF HOME HEALTH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2018
Last Update Date: 12/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1077 WILSHIRE BLVD
STEVENS POINT WI
54481
US

IV. Provider business mailing address

1077 WILSHIRE BLVD
STEVENS POINT WI
54481
US

V. Phone/Fax

Practice location:
  • Phone: 715-254-4357
  • Fax: 715-343-8863
Mailing address:
  • Phone: 715-254-4357
  • Fax: 715-343-8863

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name: KRISTA MENDYKE
Title or Position: PRESIDENT/FOUNDER
Credential:
Phone: 715-254-4357