MEDICARE: DOVE AGENCY, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251J00000X	Nursing Care Agency

General Provider Information

NPI Number	:	1063616076
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOVE AGENCY, INC.

Provider Business Mailing Address
First Line	:	1416 CUMMING AVE
Second Line	:	SUITE 2B
City	:	SUPERIOR
State	:	WI
Zip	:	54880-3757
Country	:	US
Telephone Number	:	715-392-3133
Fax Number	:

Provider Business Practice Location Address
First Line	:	1416 CUMMING AVE
Second Line	:	SUITE 2B
City	:	SUPERIOR
State	:	WI
Zip	:	54880-3757
Country	:	US
Telephone Number	:	715-392-3133
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. GREG LEIVISKA
Credential	:	RN
Telephone Number	:	715-392-3133

Provider Enumeration Date	:	06/13/2007
Last Update Date	:	04/23/2010

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Directions to “DOVE AGENCY, INC. ” Practice Location

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