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General NPI Number Information
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NPI Number | 1225209703
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Entity Type | Organization
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Legal Business Name | ST MARYS HOME HEALTH CARE OF WISCONSIN
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Dates
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Enumeration Date | 03/12/2008
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Last Update Date | 03/12/2008
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Provider Practice Location Address
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Address Line | 4265 W FOND DU LAC AVE
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City | MILWAUKEE
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State | WI
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Zip | 53216-3527
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Country | US
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Telephone | 414-874-1733
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Fax | 414-874-1737
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Provider Business Mailing Address
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Address Line | 4265 W FOND DU LAC AVE
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City | MILWAUKEE
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State | WI
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Zip | 53216-3527
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Country | US
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Telephone | 414-874-1733
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Fax | 414-874-1737
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. DOROTHY D EVERETTE
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Credential | HOME CARE
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Telephone | 414-874-1733
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 1079
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License Number State | WI
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