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General NPI Number Information
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NPI Number | 1447893094
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Entity Type | Organization
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Legal Business Name | WCSC RACINE LLC
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Dates
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Enumeration Date | 10/25/2019
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Last Update Date | 04/22/2022
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Provider Practice Location Address
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Address Line | 6011 DURAND AVE STE 500
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City | RACINE
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State | WI
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Zip | 53406-5063
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Country | US
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Telephone | 262-598-0290
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 28589
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City | GREEN BAY
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State | WI
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Zip | 54324-0589
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT OF FINANCE
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Name | JAMES NOOYEN
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Credential |
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Telephone | 920-442-4472
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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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