Provider Demographics
NPI:1164994117
Name:COPPERLEAF HOME HEALTH INC
Entity Type:Organization
Organization Name:COPPERLEAF HOME HEALTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTA
Authorized Official - Middle Name:
Authorized Official - Last Name:MENDYKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-254-4357
Mailing Address - Street 1:1077 WILSHIRE BLVD
Mailing Address - Street 2:
Mailing Address - City:STEVENS POINT
Mailing Address - State:WI
Mailing Address - Zip Code:54481
Mailing Address - Country:US
Mailing Address - Phone:715-254-4357
Mailing Address - Fax:715-343-8863
Practice Address - Street 1:1077 WILSHIRE BLVD
Practice Address - Street 2:
Practice Address - City:STEVENS POINT
Practice Address - State:WI
Practice Address - Zip Code:54481
Practice Address - Country:US
Practice Address - Phone:715-254-4357
Practice Address - Fax:715-343-8863
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-31
Last Update Date:2018-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty