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General NPI Number Information
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NPI Number | 1891142865
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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 | 06/17/2025
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Provider Practice Location Address
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Address Line | 3615 N HASTINGS WAY STE 100A
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City | EAU CLAIRE
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State | WI
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Zip | 54703-0474
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Country | US
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Telephone | 715-831-0631
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Fax | 715-831-0639
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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 | 800-489-1307
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Fax | 337-233-5764
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOSHUA L. PROFFITT
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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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