Basic Information
| Provider Information | |||||||||
| NPI: | 1376586701 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MINISTRY HOME CARE, LLC. | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | ASCENSION AT HOME | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1840 POST RD STE 5 | ||||||||
| Address2: | |||||||||
| City: | PLOVER | ||||||||
| State: | WI | ||||||||
| PostalCode: | 544672832 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7152043440 | ||||||||
| FaxNumber: | 8448870705 | ||||||||
| Practice Location | |||||||||
| Address1: | 1840 POST RD STE 5 | ||||||||
| Address2: | |||||||||
| City: | PLOVER | ||||||||
| State: | WI | ||||||||
| PostalCode: | 544672832 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7152043440 | ||||||||
| FaxNumber: | 8448870705 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2006 | ||||||||
| LastUpdateDate: | 07/23/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | SCOTT | ||||||||
| AuthorizedOfficialFirstName: | STEVEN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | VP REVENUE CYCLE | ||||||||
| AuthorizedOfficialTelephone: | 4086582768 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 07/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251G00000X | 503 | WI | Y | Agencies | Hospice Care, Community Based |
ID Information
| ID | Type | State | Issuer | Description | 43188200 | 05 | WI | MEDICAID |