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General NPI Number Information
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NPI Number | 1730992637
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Entity Type | Organization
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Legal Business Name | JEN'S ARC ANGELS, LLC
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Dates
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Enumeration Date | 01/27/2025
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Last Update Date | 01/27/2025
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Provider Practice Location Address
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Address Line | 7 S MAIN ST
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City | CLINTONVILLE
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State | WI
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Zip | 54929-1531
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Country | US
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Telephone | 920-832-8032
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Fax |
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Provider Business Mailing Address
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Address Line | P.O. BOX 193 7 S MAIN ST
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City | CLINTONVILLE
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State | WI
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Zip | 54929
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Country | US
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Telephone | 920-832-8032
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JENNIFER WATERSTRADT
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Credential |
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Telephone | 920-832-8032
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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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