1396171757 NPI number — KEEP-THEM HOME CARE LLC

Table of content: (NPI 1396171757)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396171757 NPI number — KEEP-THEM HOME CARE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KEEP-THEM HOME CARE LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396171757
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/21/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6011 DURAND AVENUE
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
MT. PLEASANT
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53406-5060
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
262-598-8140
Provider Business Mailing Address Fax Number:
262-598-8150

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6011 DURAND AVENUE
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
MT. PLEASANT
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53406-5060
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
262-598-8140
Provider Business Practice Location Address Fax Number:
262-598-8150
Provider Enumeration Date:
09/17/2013

Additional Information

Authorized Official

Authorized Official Last Name:
WILLIAMS
Authorized Official First Name:
RHONDA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/ADMINISTRATOR
Authorized Official Telephone Number:
262-598-8140

Provider Taxonomy Codes

  • Taxonomy code: 253Z00000X , with the licence number:  100030397 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100030397 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com