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General NPI Number Information
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NPI Number | 1265979348
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Entity Type | Organization
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Legal Business Name | BECAUSE THERE'S NO PLACE LIKE HOME, LLC
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Dates
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Enumeration Date | 01/26/2017
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Last Update Date | 01/26/2017
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Provider Practice Location Address
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Address Line | 473 222ND AVE
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City | SOMERSET
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State | WI
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Zip | 54025-7331
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Country | US
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Telephone | 715-417-2055
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 155
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City | STAR PRAIRIE
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State | WI
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Zip | 54026-0155
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Country | US
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Telephone | 715-417-2055
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Fax |
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Authorized Official
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Title or Position | OWNER/REGISTERED AGENT
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Name | DONAVAN HOLLENBECK
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Credential |
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Telephone | 715-417-2055
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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