=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598076911
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ACCESSIBLE HEALTHCARE, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/30/2010
-----------------------------------------------------
Last Update Date | 06/30/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | N27W23960 PAUL RD STE 200
-----------------------------------------------------
City | PEWAUKEE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53072-6233
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 262-408-5745
-----------------------------------------------------
Fax | 262-436-2117
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | N27W23960 PAUL RD STE 200
-----------------------------------------------------
City | PEWAUKEE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53072-6233
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 262-408-5745
-----------------------------------------------------
Fax | 262-436-2117
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. KEITH RYAN KOBY
-----------------------------------------------------
Credential | MBA
-----------------------------------------------------
Telephone | 262-408-5745
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 09182007
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------