=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124999487
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHIPPEWA VALLEY HOME CARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/17/2025
-----------------------------------------------------
Last Update Date | 09/17/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2607 BEVERLY HILLS DR
-----------------------------------------------------
City | EAU CLAIRE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54701-6727
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 715-491-1254
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2607 BEVERLY HILLS DR
-----------------------------------------------------
City | EAU CLAIRE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54701-6727
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 715-491-1254
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ALEXIS PHILLIPS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 715-491-1254
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------