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General NPI Number Information
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NPI Number | 1386281285
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Entity Type | Organization
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Legal Business Name | BADGER PURA VIDA LLC
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Dates
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Enumeration Date | 12/10/2019
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Last Update Date | 12/10/2019
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Provider Practice Location Address
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Address Line | 601 S MAIN ST
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City | OSHKOSH
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State | WI
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Zip | 54902-6056
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Country | US
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Telephone | 608-393-9997
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Fax |
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Provider Business Mailing Address
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Address Line | 2900 CRESTVIEW DR
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City | APPLETON
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State | WI
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Zip | 54915-3056
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Country | US
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Telephone | 608-393-9997
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Fax |
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Authorized Official
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Title or Position | OWNER/CEO
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Name | LEONORILDA RAMIREZ
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Credential |
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Telephone | 608-393-9997
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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 |
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License Number State |
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