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NPI Code Detail

MEDICARE: ST MARYS HOME HEALTH CARE OF WISCONSIN

MEDICARE: ST MARYS HOME HEALTH CARE OF WISCONSIN
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
1251E00000XHome Health Agency1079WI

General Provider Information

NPI Number : 1225209703
Entity Type Code : Organization
Provider Name (Legal Business Name) : ST MARYS HOME HEALTH CARE OF WISCONSIN
Provider Business Mailing Address
First Line : 4265 W FOND DU LAC AVE
Second Line :
City : MILWAUKEE
State : WI
Zip : 53216-3527
Country : US
Telephone Number : 414-874-1733
Fax Number : 414-874-1737
Provider Business Practice Location Address
First Line : 4265 W FOND DU LAC AVE
Second Line :
City : MILWAUKEE
State : WI
Zip : 53216-3527
Country : US
Telephone Number : 414-874-1733
Fax Number : 414-874-1737
Authorized Official
Title or Position : OFFICE MANAGER
Name : MRS. DOROTHY D EVERETTE
Credential : HOME CARE
Telephone Number : 414-874-1733
Provider Enumeration Date : 03/12/2008
Last Update Date : 03/12/2008

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Directions to “ST MARYS HOME HEALTH CARE OF WISCONSIN ” Practice Location

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