MEDICARE: DOVE 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	251E00000X	Home Health Agency	172	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790788099
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOVE INC

Provider Business Mailing Address
First Line	:	1416 CUMMING AVE
Second Line	:	STE 2B
City	:	SUPERIOR
State	:	WI
Zip	:	54880-3757
Country	:	US
Telephone Number	:	715-392-3133
Fax Number	:	715-392-3190

Provider Business Practice Location Address
First Line	:	1416 CUMMING AVE
Second Line	:	STE 2B
City	:	SUPERIOR
State	:	WI
Zip	:	54880-3757
Country	:	US
Telephone Number	:	715-392-3133
Fax Number	:	715-392-3190

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

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	04/23/2010

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Directions to “DOVE INC ” Practice Location

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