Provider Demographics
NPI:1083040919
Name:MANITOWOC HOMECARE
Entity Type:Organization
Organization Name:MANITOWOC HOMECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:
Authorized Official - Last Name:SEIDL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-684-7155
Mailing Address - Street 1:1004 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-5207
Mailing Address - Country:US
Mailing Address - Phone:920-684-7155
Mailing Address - Fax:920-684-8653
Practice Address - Street 1:1004 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:MANITOWOC
Practice Address - State:WI
Practice Address - Zip Code:54220-5207
Practice Address - Country:US
Practice Address - Phone:920-684-7155
Practice Address - Fax:920-684-8653
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-24
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health