Basic Information
| Provider Information | |||||||||
| NPI: | 1740626332 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | REHAB ARISCES HOME HEALTH SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 845 S MAIN ST STE 120 | ||||||||
| Address2: | |||||||||
| City: | FOND DU LAC | ||||||||
| State: | WI | ||||||||
| PostalCode: | 549356116 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9203220447 | ||||||||
| FaxNumber: | 9203221362 | ||||||||
| Practice Location | |||||||||
| Address1: | 845 S MAIN ST STE 120 | ||||||||
| Address2: | |||||||||
| City: | FOND DU LAC | ||||||||
| State: | WI | ||||||||
| PostalCode: | 549356116 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9203220447 | ||||||||
| FaxNumber: | 9203221362 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2013 | ||||||||
| LastUpdateDate: | 05/22/2013 | ||||||||
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| AuthorizedOfficialLastName: | TAYLOR | ||||||||
| AuthorizedOfficialFirstName: | JENNIFER | ||||||||
| AuthorizedOfficialMiddleName: | LYNN | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 9203220447 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | Y | Agencies | Home Health |
No ID Information.