Basic Information
| Provider Information | |||||||||
| NPI: | 1699722124 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MINISTRY HOME CARE SERVICES, LLC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | ASCENSION AT HOME | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 10050 S 27TH ST STE 100 | ||||||||
| Address2: | |||||||||
| City: | OAK CREEK | ||||||||
| State: | WI | ||||||||
| PostalCode: | 531545520 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8006488055 | ||||||||
| FaxNumber: | 4145630600 | ||||||||
| Practice Location | |||||||||
| Address1: | 10050 S 27TH ST STE 100 | ||||||||
| Address2: | |||||||||
| City: | OAK CREEK | ||||||||
| State: | WI | ||||||||
| PostalCode: | 531545520 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8006488055 | ||||||||
| FaxNumber: | 4145630600 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/29/2006 | ||||||||
| LastUpdateDate: | 07/23/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | SCOTT | ||||||||
| AuthorizedOfficialFirstName: | STEVEN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | VP REVENUE CYCLE | ||||||||
| AuthorizedOfficialTelephone: | 4086582768 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | MINISTRY HOME CARE INC | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 07/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | N | Agencies | Home Health | 251F00000X | N | Agencies | Home Infusion | 332BP3500X | 8335 | WI | N | Suppliers | Durable Medical Equipment & Medical Supplies | Parenteral & Enteral Nutrition | 333600000X | 8335 | WI | N | Suppliers | Pharmacy | 3336C0003X | 8335 | WI | N | Suppliers | Pharmacy | Community/Retail Pharmacy | 3336H0001X | 8335 | WI | Y | Suppliers | Pharmacy | Home Infusion Therapy Pharmacy |
ID Information
| ID | Type | State | Issuer | Description | 5126568 | 01 | NCPDP | OTHER | 33247600 | 05 | WI | MEDICAID | 8335 | 01 | WI | RX LICENSE | OTHER |