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General NPI Number Information
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NPI Number | 1659728616
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Entity Type | Organization
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Legal Business Name | HHA OF WISCONSIN, LLC
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Dates
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Enumeration Date | 05/19/2016
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Last Update Date | 07/29/2020
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Provider Practice Location Address
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Address Line | 3900 HALL AVE SUITE A
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City | MARINETTE
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State | WI
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Zip | 54143-1062
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Country | US
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Telephone | 715-735-6490
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Fax | 715-735-6461
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Provider Business Mailing Address
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Address Line | PO BOX 51266
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City | LAFAYETTE
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State | LA
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Zip | 70505-1266
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Country | US
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Telephone | 337-223-1307
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Fax | 337-443-4154
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Authorized Official
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Title or Position | EXECUTIVE VICE PRESIDENT
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Name | MR. NICHOLAS GACHASSIN III
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Credential |
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Telephone | 337-233-1307
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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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