1821182981 NPI number — MINISTRY HOME CARE SERVICES, LLC

Table of content: (NPI 1821182981)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821182981 NPI number — MINISTRY HOME CARE SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MINISTRY HOME CARE SERVICES, 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:
6
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:
1821182981
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/17/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
611 ST. JOSEPH AVENUE
Provider Second Line Business Mailing Address:
4 SOUTH
Provider Business Mailing Address City Name:
MARSHFIELD
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54449-1832
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
715-389-3802
Provider Business Mailing Address Fax Number:
715-387-9950

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2074 AMERICAN DR
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
NEENAH
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54956-1002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
920-832-8874
Provider Business Practice Location Address Fax Number:
920-832-9288
Provider Enumeration Date:
10/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KAMINSKI
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
SENIOR DIRECTOR OF FINANCE
Authorized Official Telephone Number:
715-387-7294

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  004-0000579853-01 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332BX2000X , with the licence number: 004-0000579853-01 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 41709900 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 456-0000579853-02 . This is a "SELLER'S PERMIT" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".




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