Healthcare Provider Details

I. General information

NPI: 1013852482
Provider Name (Legal Business Name): KICKAPOO CARES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2026
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 N MAIN ST
WESTBY WI
54667-1106
US

IV. Provider business mailing address

110 N MAIN ST
WESTBY WI
54667-1106
US

V. Phone/Fax

Practice location:
  • Phone: 608-634-2365
  • Fax: 608-634-6388
Mailing address:
  • Phone: 608-634-2365
  • Fax: 608-634-6388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: DR. ANTHONY F SHAY
Title or Position: OWNER/EXECUTIVE DIRECTOR
Credential: ED.D., LPC
Phone: 608-634-2365