Healthcare Provider Details

I. General information

NPI: 1346547197
Provider Name (Legal Business Name): SEKARA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2011
Last Update Date: 02/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1916 BROOKVIEW CT
WAUSAU WI
54403-9327
US

IV. Provider business mailing address

PO BOX 1441
WAUSAU WI
54402-1441
US

V. Phone/Fax

Practice location:
  • Phone: 715-845-1110
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: JEFF BURGOYNE
Title or Position: OWNER/MEMBER
Credential:
Phone: 715-551-0269