=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487808697
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RUDOLPH ENTERPRISES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/14/2008
-----------------------------------------------------
Last Update Date | 11/14/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5396 KING JAMES WAY STE 210
-----------------------------------------------------
City | FITCHBURG
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53719-1798
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-442-1898
-----------------------------------------------------
Fax | 608-442-1899
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5396 KING JAMES WAY STE 210
-----------------------------------------------------
City | FITCHBURG
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53719-1798
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-442-1898
-----------------------------------------------------
Fax | 608-442-1899
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF EXECUTIVE OFFICER
-----------------------------------------------------
Name | MR. STEPHEN P. RUDOLPH
-----------------------------------------------------
Credential | FACHE, CSA
-----------------------------------------------------
Telephone | 608-442-1898
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------