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Agencies Home Health

Provider NPI: 1083090559

Organization Information:
Organization is not Subpart
Authorized Official:  SHAWNA  ROHDA  OWNER  262-744-1473

Practice Location:
2951 N RIVER RD  WATERFORD, WI 53185-5082 US
Tel: 262-744-1473  Fax: 262-514-3485

Business Mailing Address:
2953 N RIVER RD  WATERFORD, WI 53185-5082 US
Tel: 262-744-1473  Fax: --

NPI Information:
NPI: 1083090559
Entity Type: Organization


PrimaryCodeCategory/DescriptionStateLicense Number
Home Health
N261QA0600XAmbulatory Health Care Facilities
N261QD1600XAmbulatory Health Care Facilities
N261QM0850XAmbulatory Health Care Facilities
N3104A0625XNursing & Custodial Care Facilities
Assisted Living Facility
N3104A0630XNursing & Custodial Care Facilities
Assisted Living Facility
N310500000XNursing & Custodial Care Facilities
Intermediate Care Facility, Mental Illness
N311ZA0620XNursing & Custodial Care Facilities
Custodial Care Facility
N320600000XResidential Treatment Facilities
Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities
N320700000XResidential Treatment Facilities
Residential Treatment Facility, Physical Disabilities
N320800000XResidential Treatment Facilities
Community Based Residential Treatment Facility, Mental Illness
Y320900000XResidential Treatment Facilities
Community Based Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities
N323P00000XResidential Treatment Facilities
Psychiatric Residential Treatment Facility
In Home Supportive Care
Community/Behavioral Health

Other Provider Identifiers:


American Medical Association 2012 taxonomy code information

Code: 320900000X





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