MEDICARE: ANS PERSONAL CARE FOX VALLEY WEST

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	253Z00000X	In Home Supportive Care Agency		WI

General Provider Information

NPI Number	:	1235673021
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANS PERSONAL CARE FOX VALLEY WEST

Provider Business Mailing Address
First Line	:	1551 S 108TH ST
Second Line	:
City	:	WEST ALLIS
State	:	WI
Zip	:	53214-4020
Country	:	US
Telephone Number	:	414-481-9800
Fax Number	:

Provider Business Practice Location Address
First Line	:	1551 S 108TH ST
Second Line	:
City	:	WEST ALLIS
State	:	WI
Zip	:	53214-4020
Country	:	US
Telephone Number	:	414-481-9800
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	KIM ELLIS
Credential	:
Telephone Number	:	414-481-9800

Provider Enumeration Date	:	12/13/2016
Last Update Date	:	12/13/2016

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